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446 Septic Applications Application Approved By t�-es.- -.� - <<!?1 .-. nrMAt7. Application Disapproved for the following reasons- Date Permit No Issued Date ERE APPLICABLE .z. .a. , a 0 U W U 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