Lot 2 Septic Appication & Permit by
at
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.. 4y ''
rrtifiratr of flinmplianrr
THI T 2TIF Tl»t Individual Sewage Disposal System constructed (4 ) or Repaired
1
�o
has been installed in accordance with the provisions of Articl aI The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 0¢ - dated / 17 iXiS
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTION SATISFACTORY. or/
DATE e. f ..,....o(.� _i-k 75 Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
•
OF /
J J
Jinyn.ial 3llarko (nnsiructinnt lrrmit
FEE
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
as shown on the application for Disposal Works Construction Permit No Dated
Bvenl of Health
DATE
FORM 1255 HOBBS B WARREN, INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No..�(j_.6 6
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF A13 "C,r-et
Application for fispusttl 3Slurks �uimtrurtiuu Urrinit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Indi,idual Sewage Disposal
System at: lopp `pr j ?Pte, #
Address
Type of Building pp
Dwelling—No. of Bedrooms J Expansion Attic
Other—Type of Building No. of prirona
Other fixtures
Address
Size Lot Sq. feet
( ) Garbage Grinder (1.-<Showers ( ) — Cafeteria ( )
Design Flow 3 6 gallons per person per clay. Total daily flow gallo .
Septic 'Fell: Liquid cap acit >g_gallons Length VVidth I gallon,.iameter Dea
Disposal Trench—No Width Total Length Total leaching area Fj 0- d
Seepage Pit No Diameter Depth below inlet Total leaching area
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. I 1.3 minutes per inch Depth of Test Pit Depth to ground watr I ])
Test Pit No. 2 minutes per inch Depth of Test Pit__7 Depth to ground water .1 6
sq. ft.
ft.
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitar ode—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ie+n ue by tlg boa of I Ith.
9'P/.i natyq.t% 7S
Application Approved By ' - ��-f°���-21-,-��� i ��'�un r
d
Application Disapproved for the following reasons
Permit No._-!..!
. AULIIJII.Li-MIS/ISIS
N
U
a.
0
U
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
077 OF AipergAmProg
atonstrurtion Permit
Application for Disposal
Application is hereby made for apron to Construct
System at: 41=-CC-0,70
Hoe et/ Zeibilia
Aem ce `.°kIecTryiee,u,
Owner
Installer
Fax
or Repair ( ) an Individual Sewage Disposal
a
or Lot No.
Address
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures
Design Flow
Septic Ta
Disposal
Address
Size Lot.....ar Zi37 Sq. fees/
Garbage Grinder (-")
Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow Se'rr, gallyns.
,iquid capacity/MOgallons Length...L(2k) Width.. --0 "Diameter Depth
—No. 1 Width Zee' To Length C ' To leaching area (at-na...sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Do& tank ( )
Percolation Test Results Performed by giagfleZeft-1,22 .. nAl "ill(e/Z.Zefettpate. -5/ZO 74-
Test Pit No. 1../.3 minutes per inch Depth of Test Pit..3 -9" Depth to ground water..Al.a.d.1.41...
Test Pit No. 2 minutes per inch Depth of Test Pit. 7= , '1 Depth to ground water --C ' C '
'"-,3"1 C.:7.4.e,v..E_ c-,44.40 i -7/C-.7- e
i
Description of Soil a on
Ka-Z
apdv 04. Ad
z 61 Si
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 by the board of health.
Application Approved By
Signed
Application Disapproved for the following reasons
Permit No
Date
Date
Date
Issued
Date