Lot 8 Septic Appications UU
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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Application for Binpnnnl arks alonstrurtion hermit
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Application is hereby made for a Permit to Construct (✓ ) or Repair ( ) an Inds idual Sewage Disposal
System at:
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li Lw no
Type of Building Expansion Attic
Dwelling—No. of Bedrooms No of person=
Other—Type of Building
Other fixtures
Design Flow _ gallons per person per day. Total d
�tL2 gallons Length Width
Septic l Tank
Tr nc Liquid capacity —6 Total Length--
Disposal Pit No Width
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
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Address
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
ily
flow gallons.
Diameter Derypthq
Total leaching area �y.4.'..Q.-sq. ft.
Total leaching area sq. ft.
Description of Soil
Date
Depth to ground water
Depth to ground water
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersign • further rees not to place the system in
operation until a Certificate of Compliance has been issued by the b d -_
Signed _L ✓><vs k
Application Approved By
,�:: . N�S a. _-,�'! L'a�,4tt* 1 ILA : Laeii #Li/.
Application Disapproved for the following reasons'
Permit No
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Issued O.LC_ / !4..1J
Date r.
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has been installed in accordance with the provisions of Article XI of The State Sanitary nitary 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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Oirrtifirnte of fdnmplinnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
)
i,,,mee.
Inspector
ERE APPLICABLE
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No.._9..1_d._.__..
THE COMMONWE
RD/A�nOF F MASSACHUSETTS
HEALTH
H
v U OF . .1./..�M L"
Application -fur Ot5puuall Wurl w Nlanstrurtinn Permit
( - ( I Individual Sewage posit'
Application is hereby made for a Permit to Construct ( �r Repair ) a=�
System at: /1 r 2.1.‘11(-4
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Size Lot. Sq. feet
Type of Building _ r_Expansion Attic ( ) Garbage Grinder ( )
6
Dwelri—Type of Bedingms_-. - _ Showers ( ) -- Cafeteria ( )
Vn o, pr � --
Oiher—Type ri Guilr mg -___.
Other h t r s - 1 on.
llon per person per day. Total d 1 —Septic Tank - Width. Ur.m t DQQG `.I. (,_
(JQG_ uh,t Ad Total leaching
St tic fauk—Liquid vi nett _ P'idth_-r�l} --Total Length. ri, i�.
Disposal Pit No—Ni Depth below inlet Total lead .t a rev.
t
Diamete�
Seepage Pit Soo Dosing tank ( )
Other Distribution box ( ) Date
Performed by._ --- water.Percolation Test Results . . Depth to ground Test Pit So. 1 minutes per inch Depth of e t Pit_- Depth to ground war ' - -
Test Pit No. � minutes per inch Depth of Test Pit. - _-
sddrvss
V Description of Soil__---
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W __.. __ _. Answer when applicable
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Nature of Repairs or Alter -_--
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The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
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 tss� d•
Signal
lute
Application Approved By °,
Application Disapproved for the following reasons:- l odic
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Issued. --+a.-.-;74r
Permit No._kL r n�« nea
rameas•W
CHECK OR FILL IN WHERE APPLICABLE
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
of YjCtl�¢ t/
Application for flispnsrl Works Cnnnstrurtian Permit
Application is hereby made for a Permit to Construct
System at: r I n cpj
ess
Kt—
Ins
(v)
or Repair ( ) an Individual Sewage Disposal
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 persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow /....` gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacityl .gallonss Length Width Diameter Depth
Disposal Trench—No. Width Total Length_] Total leaching area../&.L 6 sq. ft.
Seepage Pit No - Diameter Depth below inlet Total leaching area sq. ft.
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
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
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:IT Isis 5 of the State Sanitary Code—Th ulersigned ft her agrees not to place the system in
operation until a Certificate of Compliance has been i •+. b e bs - o health
Si
Application Approved By
Date Daate
Application Disapproved for the following reasons'
by
Permit No._Q 3fia-
Issued. zat. (>2(F 7t
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
aiertifiratr of tdumplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cnde as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATF Inspector