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Lot 11 Septic Appications ECK OR FILL IN WHERE APPLICABLE No....6..zCF...S_....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF FEE..� 7 1ppliratinn fur Qispnsal Winks CIunstrurtiun hermit Application is hereby made for a Permit to Construct (/5) or Repair ( ) an Individual Sewage Disposal System at: .4 aliag. .. j 1// .',6J/yLtata tro{yy@/y�(t;��(/q/K}, or Lot No. °•�^kflner.. 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 ,,tt gallons per person per day. Total daily flow gallons. Septic Tank—Liquid capacitOW ...gallons Length Width Diameter Depth Disposal Trends—No. Width Total Length Total leaching area—ja.e.d.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. Test Pit No. 2 Description of Soil Nature of Repairs or Alter nswer when applicable Agreement: The undersigned agrees to install the aforedescrihed individual Sewage Disposal System in accordance with the provisions of TIT Lid 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,$ssue e boar Health. Application Approved By I� 9.re Hate Application Disapproved for the following reasons by Permit No..ea-T.51-- Issued... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Qtertifiratr of Ctnmplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at has been installed in accordance with the provisions of Ti?i._ 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 S/.1 ._I C C Type of Building Size ° 3 O 3 S feet U- Dwelling—No. of Bedrooms Expansion t he ( ) Slec Got Gathage Grinder 9( v W Other—Type of Building _.J;.4AIC rf No. of persons Showers ( ) — Cafeteria ( ) R. No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cu. - OF k(OCTNpY(pi_o Y.f Application for L1itfisual Mliork, (riots fritrIimt mutt# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System Q at: 4Uf T S E F Co4O , ,t/( T/ YJ.0 CaEC'a E. 60--)X70 r( Addres-s Other Gxt tires W Design Flow 50 gallons per person per day. Total daily flow ...500 tsJ • Septic Tank—Liquid capacity/000 gallons Length Width Diameter Disposal Trench--- No Width Total Length '-' Total Ruching area 5 Seepage Pit No Diameter . 1)epth below inlet Total leaching area ▪ Other Distribution box (11 Posing tank ( ) ▪ Percolation Test Results Performed by d', O'4 TES . Test Pit No. i /6 7 minutes p:r inch f=+ Test Pit No. 2 minutes per inch FS O Description of Soil (a"LV A/1 V .2 Depth 400 L) u Depth of Test Pit 7 O I)eptb of 'rest Pit Depth to ground water gallons. sq.ft. sq. ft. Date VC"- S_/9.]/ Heigh fn ground water 'UO. G:i�), Co =Lc 7 Nature of Repairs or Alterations—Answer when applicable S4vo. 'r1°° Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to operation until a Certificate of (on'i 1'ancc has been issued by the hoard of health. Signed Application Approved By Application Disapproved for the following reasons in accordance with place the system in Date Dae Date Permit No Issued ohs by THE COMMONWEALTH OF MASSACHU5ETT6 BOARD OF HEALTH OF QIrrtificulr of frimpliitatrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) In,t Wei at lets been installed in accordance with the provisions of .Article XI of The State Sanitary Cale as described in the application for Disposal Works Construction Permit No doted THE ISSUANCE OF THIS CERTIFICATE SHALL NOT DE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE vvvvv CHECK OR FILL IN WHERE APPLICABLE No....1..1..6L FEE..l.2 t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OFxU C, Appliratiun fur lispnsal r;c arks fnunntrurtiun tirrtnit Application is hereby made for a Permit to Construe System at: ( or Repair ( ) an Individual Sewage Disposal t..s 11 —r yl Lot No. rAddress Installer Address 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 capacityJS$allons Length Width Diameter Depth Disposal Trench—No. Width Total Length Total leaching area 1G..a...-aq. 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 been issued byth board of health. Application Approved By ,�.. c 2G.f .x 7 Qi -- J2/ 1 om Application Disapproved for the following reasons Permit No 1 / s Issued pp Date // 77 • by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF f2rrtifirate of fdumplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) Installer 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