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Lot 13 Septic Appications CHECK OR FILL IN WHERE APPLICABLE No...17 1/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF /HEALTH �y OF r -: Apptiratinn for topcoat i i'!who 'dnnntrurtinn Vaunt Yea._/.5l a a Application is hereby made for a Permit to Construct (V or Repair System at: Type of Building Dwelling—No. of Bedrooms 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 capacity/ 'gallons Length Width Diameter Depth Disposal Trench—No Width Total Length Total leaching area fo 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 an Individual Sewage Disposal /_3 or Lot Address Address Size Lot Sq. feet Expansion Attic ( ) Garbage Grinder ( ) 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 Application Approved By e yed by the board of health. PP PP Y Signed '�Y1::11.��b' '�-red _.x T- r- ,,J.operation until a Certificate of Compliance has been issued — h. ..LY.. Q,�c_lf�2.1 y }�-�p D.E../97/ it Application Disapproved for the following reasons Permit No 1-L..1 1-1 by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF . . .. Crrtifirtttr of Otumplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired 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 • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITE OF dLo era Ali prod Application fur lis}Tuna! 3tlnrttn Qlnnsfrnrfinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: &EIS ,QIT ecAO A/0 , i3 Loc�lro,r. n acQgsag F4f TOt) owner or Lot No. Address Installer Address /O SQO Type of Building `_3 Size Lot ,e Sq. feet Dwelling—No. of Bedrooms 4 Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..CAFE No. of persons S Showers ( ) — Cafeteria ( ) Other fixtures Design Flow So gallons per person per day. Total daily flow 460 gallons. Septic Tank—Liquid capacity/000gallons Length Width Diameter Depth Disposal Trench—No. Width Total Length Total leaching area 48 sq. ft. Seepage Pit No Diameter Depth below inlet. Totl1ea 'ling area sq. ft. Other Distribution box (A Dosing tank ( Tot P� t. Percolation Test Results Performed by 4 a£053, Hooray A`-f(r Date Ay,Oc Z /2Z/ y...... Test Pit No. 1 ..4 Q minutes per inch Depth of Test Pit & Depth to ground watcr..VD,_G..1[a Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil Ca .44IIEK...:......( LQA.!i y 5 ' .$4& V Wi rel 7246E n G QAVe.l, Z f!M.c........G e 15AN0 LQ Tr/ &'r7E 51r.1% /UMI! Nature of Repairs or Alterations—Answer when applicable 4. ,% O /) .I Agreement: /y��� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article N I 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 hoard of health. Signed Date Date Date Permit No Issued Doe Application Approved By Application Disapproved for the following reasons-