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87 Septic Application 1995 CHECK OR FILL IN WHERE APPLICABLE 4P 20 Fax_.....—_ THE COMMONWEALTH OF MASSACHUSETTS ay BOARD ,t OF}7-fHEALTH c i l iratiun far ilis#fusttl Mirka Cnunstrurtian f ermi# Application is hereby made for a Permit to Construct ( ) or System at: CHasitREIELO ROAD 6ob 647:r Installer Type of Building Dwelling—No. of Bedrooms Individual Sewage Disposal ca (ma F ,0 Address 0 4.y'r � Expansion Attic Other—Type of Building .51Nire... LrIt No. of persons Q Other fixtures Design Flow SS" gallons per person per day. Total daily flow Septic Tank—Liquid capacity sal Trench—No. i" Address Size Lot Sq. feet Garbage Grinder (L- Showers ( ) — Cafeteria ( ) gallons Length Width / Diameter Depth gallons Dispo Width 3 Total Length 35 Total leaching area._..✓]%&.sq. ft. Seepage Pit No ',( Diameter Deptl below inlet Other Distribution box (v / Dosing tank Percolation Test Results Performed by_..l.Lw' Test Pit No. I s?--- minutes per inch Depth Test Pit No. 2.......1 —minutes per inch nn Depth o Description of Soil LFO N\- $&A0/6— t k_ - M f' StewP Total leaching areas sq. ft. Date..11v6V.]1 1491 est Pit j..2..0:Depth to ground water.../J.ONC... Test Pit /ZV Depth to ground water....8' Nature of RepaAs or Alterations—Answer when applicable__.K.EP. .._Paulo_& L.e ::tip-I Cr Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Application Approved By Sfy llorr Application Disapproved for the following reasons Permit No Date Issued.