446 Septic Applications Application Approved By t�-es.- -.� - <<!?1 .-. nrMAt7.
Application Disapproved for the following reasons-
Date
Permit No Issued
Date
ERE APPLICABLE
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No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O . HEALTH
FEE
.Application for tispunal Marks 1iunntrurtiun lirrmit
Application is hereby made for a Permit to Construct ('\ ) or Repair ( ) an Individual Sewage Disposal
System at:
Location:Address - or Lot No.
Owner
Address
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building P Ie1IL4.9 No. of persons e= Showers ( ) -- Cafeteria ( )
Other fixtures
Design Flow 54allons per person per day. Total daily flow Z6 C._gallons.
Septic Tank—Liquid capacityled U gallons Length Width Diameter Depth
Disposal Trench—No. Width / Total Length ..3.4 2 Total leaching area -7 O.Q.sq. ft
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box (//5 Dosing tank ( )
Percolation-Test Results Performed by - xt • " e'`` ' y Date ' -°'
4 Best Pit Noj minutes per inch Depth of Test Pit's^ F Depth to ground water=- - - -
r ett 0 2 �yminutes per inch Depth of Test Pit Depth to ground water
_._.� // + • ,r rt-'-r t" _ a
..
Description of Soil :�
ft.{..,,f,..'. �"._k ,,.1... ..�.2 c 4: (>¢ _t f r` fe k �.L;, Y g.._.,. ,f-,.. %
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 AT 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 board of health.
d
No. �1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
JA� OF /"r/ ,-rKPTOJ
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application Har a Pormh to Condo act t ) Repair t tIpgrado ( 1 Abandon f ) - C complete System •Individual component.
446' C4s�-n-re64)__ rat
J((' rA+i-` Mc n/
0nn yln,e
414, CEs eRru5 Rd !E€n,5 ; rink
09 st —9966
Talcphn"e
t"L'I'n
to,.
' `ifft-
HOWARD ENVMORNEATAL SERVICES
near.,.
750 NORTH PL ASMAL STHEtl (REAR)
IVHE•S1 tut AIM
Telephone•
TicpM1wct
Type of Building: S • "V • PI •
Dwelling—No.of Bedrooms FOU r2
Other—Type of Building
Lot Size O3Z*S.,. f..t
Garbage Grinder (Le
No. of persons Showers ( ), Cafeteria ( )
Other fixtures
2pd.u�
Design Flow(min required) //U_ _gpd/'�Cnlculated design flow and Design flow provided gpd
Plan: Date 9)24 / Number of sheets Revision Date
Tale \U&SC4&AC /1/if0s'41 _
Description of of Soil(s) s« Gn 1
Soil Evaluator Form No. Name of Soil Evaluator kref e Date of Evaluation W3/9
DESCRIPTION OF REPAIRS OR ALTERATIONS
178, t SA . .
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
THIS 5 and further ees not to place R'F systep in operation until a Certificate of Compliance has been issu by the Board of Health.
aigned "Lv,A
Inspections
Date 0,6 Jam! 26 (F%7
7
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96