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Lot 9 Septic Appications ..•-•-•,•-••W,,IT-.111....111-11■R CHECK OR FILL IN WHERE APPLICABLE Nod Pas S- THE COMMONWEALTH OF MASSACHUSETTS ,1 BOARD OF ((HEALTH y C.itC OF . LA.1ZL 'te''D Appliration for bfoposnl i or j Qtnnwlntrtinn IPrmit Application is hereby made for a Permit to Construct (l' ) or Repair ( ) an Individual Sewage Disposal System at: �i ? Location s or Lot No. a�( — `` ryry Address .._�ll_(::y Ivtaller 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 capacitJl5 i gallons Length Width Diameter Depth Disposal Trench —No. Width Total Length Total leaching area 6 ' Csq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in � operation until a Certificate of Compliance has beG ry issued by the �M%'I he I Signed../..`,.f.�.pl. / Application Approved By - "'°M � x / __-L Lt'g D.,� l f Application Disapproved for the following reasons Permit No...%f Issued e" - --2.-/.y.7j by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Trrtifiratr of (IIomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) u holler 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 dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector CHECK OR FILL IN WHERE APPLICABLE No....2 .r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( OF 1�ppliration four finponai Marko nnstrurtinn hermit Faa.. t O Application is hereby made for a Permit to Construct System at: or Repair ( ) an lndioidual Sewage Disposal or Lot No. Ox'yfd R 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 capaci di.gallons Length Width Diameter Depth Disposal Trench— No. Width Total Length Total leaching area.._ mdsq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or Alterations— wer when applicable Agreement: The undersigned agrees to install the aforedeseribed individual Sewage Disposal System in accordance with the provisions of TIT 2. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i5su�d by boo.d. health. % Si d all q/ec Application Approved By . .'. -4 /� Application Disapproved for the fallen by Permit No...6..37 Issued_. SNOW THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Dat Crrtifiratr of tbontplitturr THIS IS TO CERTIFY, That the Individual Sew'uge Disposal System constructed ( ) or Repaired ( ) mstauer at has been installed in accordance with the provisions of TITI: 5 of The State Sanitary Code 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