Lot 8 Septic Appication & permit 1976 WHERE APPLICABLE
CHECK OR FILL
N.._I 1_3
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF {HEALTH
OF t
Appliratiuu-far Uinpuoal lurks Cnaudinu Jrrutit
Fee_13 0 '
Application is hereby made for a Permit to Construct
System at:
OtrJ¢
/J .J
Ivsad tx
or Repair ( ) an 1ndit ideal Sewage Disposal
sw
or Lot No.
Address
Address
Type of Building
Size Lot Sq. feet
Dwelling—No. of Bedrooms —Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .. No. of persona Showers ( ) — Cafeteria ( )
Other fixtures Blom
Design Flow gallons per person per day. Total daily to ti g
Septic lvik-Liquid capacit42.51 .dlons Length Width Diameter Dynh.
Disposal Trench No. Width Total I ength Total leaching t g arca_- sg_ft.
Seepage Fit No Diameter Depth hel ow inlet Total leachiU arcii` �p ail. u.
Other Distribution box ( ) Dosing tank ( ) / O 0 d 34 'y-�1}3ef
Percolation Test Results Performed try - (J Date Il
Test Pit No. I minutes per inch Depth of Test Pit Depth to ground mite-
Test Pit No. 2 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 aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI 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.
Signed .p._
Application Approved By � 'L--/^%- '
Application Disapproved for the following reasons
att-Lregi 97,E
of
Permit No.__/_�_�
Issued
Date
is; 19,2k
Date
by
at
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
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
OF
Trrtifiratr of faom}+liaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
[r=ealer
No 713
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF�HEALTH
y�
el- OF C U y
Uthp Ott orlts �n trurtion Permit
Permission,i eereby granted E- ,, "'��'''"'^'
to Construe ( ) or Repair ) an Ind yr a ewage Disposal System
at No �J- t- Si4ekis street
as shown on the application for Disposal R'orla vstruction P it No
7/3 llated.
FEE.7/>3
DATE
FORM 1255 HOBBS 6 WARREN. INC.. PUBLISHERS
/,2f/!1,6