331 Septic Permit 1963 Type of Building ...Expansion Attic ( / — Cafeteria ( )
Other-—No. of Bedrooms..___....- ----No. of persons Showers ( )
Other-
Othe of Building .._._..._____..
Other fixtures _.---- -'
gallons per person per day. Total daily flow
Diameter ����_-�����Delrth._..._----��.�
Septic Tank Liquid l Tr nc Liquid capacity L.........gallons Length-_.._-Le Length Total ac ing area-.4.'-u_d.--sq• ft.
Disposal Pit No—No. —'-"Diameter - -- Dept below inlet "Total l teething area , sq.. ft
Seepage D Pit No Dosing tank ( )
Other Distribution box (✓) _._._.. Date..
Percolation Test Results Performed by__.._.._ Pit to ground water.
Depth Depth to ground water.._.._._.........._
._._ i..__._._._. - _.._._....._.._.
Test Pit No. I__....__.._minutes per inch Depth of Test Pit
Test Pit No. 2..._._.__...nunutes per inch Depth of Test Pit ........................................._._-„_„---
.. .._.._.._..
Descriptionof Soil....................................................................................................................................................................
Nature of Repairs or or Alterations when applicable. ........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code- by the hoard further agrees not to place the system in
operation until a Certificate of Compliance has been Y. , �. �..
Signed.____._...._..__..._..___._.._._ _.
......... _.._..
Application Approved By-�-�------°""'
Application Disapproved for the following reasons:... .. ..
Issuedt._ _n,a
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
jalertifirate of ( 4iniilittnre •
or Re aired ( )
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( P
by
mean
has been installed in accordance with the provisions of Article X1 of Ted. State Sanitary Code as described � the
at. y t
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. _ : :- _ :_ .-_-..,._..
._..-__.5�...'.'......._.____......_. ... Inspector._._._.
DATF
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
No.....
nispssttl new Tonstrurtinn jermit
FEE
anted.._...___.._.:_ .... ......_..:.:_._..__..__.._..
.._......._.......
Permission is or Repair ) an Individual Sewage Disposal System
at to No onstmct ( ) .__...............__.....-.......... Street
as shown on the application for Disposal Works Construction Permit D a t e d te
Board of Heal
DATE. .......
FORM 1236 Hosts & WARREN. INC.. PUBLISHERS