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:
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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