Lot 7 Septic Appication Permit & Plans HERE APPLICABLE
CHECK OR PILL IN
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
rift' of NB/'fflcrfnitle
Appliratinu for tf- hilts at 3flnrka CInutitrurtinn Tirrut
F
Application is hercb . made for a Permit to Construct (X) or Repair ( ) an Indic'dual Sewage
System at: f3:,c /"a./tJ tor fr oft..
Weta..Jfic}u1Rit ion
. s l
j Q .L 7
/axh_ Awe or tSo
nta { n lIL az!Locmian-Aes
Owner Attu
Installer Address
Type of Building Size Lot-1L!..37 Sq. feet
Dwelling—No. of Bedrooms -.3 Expansion Attic ( ) Garbage Grinder (V)ye>
Other—Type of Building - No. of persons Showers ( ) -- Cafeteria ( )
Other tisunes
Design Flow SC .J? 6 gallons per person pc day. Total daily flow 3C1.O gallon..
Septic '1 1 —Liquid c pacify' .gtdlons Length Width _ . Diameter De��ih E44
Disposal -h . i-!C!A_ Width L8 Total Lc igth._e7 f 'Dotal leaching zit-ea__:3' 2P' sq. (!.
Seepage Pit No Diatneter Depth below inlet Total leading are sq. C.
Other Distribution box ( ) Dosing tank ,(, ) �/ � p 3--2S--73
Percolation Test Results Performed hy-....r%.G:Yt° t.-R_-d i.am-i F� Date-
Test Pit No 1 Z minutes per inch Depth of cst Pit 70e Depth to ground way- 9,c'
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water-. .
Description of Soil 0 6) l_7Llp sci/.-ci 10.A.Se 6 - 241„ Si f'fy Sand_5Ai JCCst.-7,
V" - 1C' sand w/0c se" Sc' Io 7c" sand 5-14) firm .
Nature of Repairs or Alterations—Answer when applicable
Agreement: -
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System nt accordance with
the provisions of Article N1 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.
Signed
Application Approved By
Application Disapproved for the following reasons'
Permit No Issued Date
Date
Date
Date
b
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
«trrtifiratr of fdnmplitturr
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 X of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated
THE ESSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
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CIIECK OR FILL IN WHERE APPLICABLE
No 12 D
THE COMMONWEALTH OF MASSACHUSETTS
FEE.
a
BOARD,} OF�LHEALTH
(±L- OF )A{i-I-t lt2t-t{ f:—:t.. .
) ppliratinn foruldiopoOat iffnrkB Ciinnntrurtinu P7rrntit
Application is hereby made for a Permit to Construct (I ) or Repair ( ) an Individual Sewage Disposal
System at:
{ .v
C)I *trL LSD. Id tic)
o address
s.kt 41 ` lt_ L" ,f,en-
,,
I lortoller Address
Size Lot Sq. feet
Type of Bti ldine " ,�
Dwelling—So. of Bedrooms __Expansion Attic ( ) Garbage Grinder (r/
Other—Type of Building No. of person: Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow .J gallons per person per day. Total daily tJow lee { gallon._
Septic Tank—Liquid crpac t/ Lt.gallons Length Width _ __ Diamete- Deptlr.
Disposal Tench— No Width 9-L t Total Length iL 'total leaching area (_c6 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leadtiug area sq. it.
Other Distribution hox ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1—. .._minutes per inch Depth of Test Pit Depth to ground watt-
-
Test Pit No. 2 minutes per inch Depth of "test Pit 7' Depth to ground water --
or Ljt No.
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 N1 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.
Sipn5I
tiv Sfi
J
Application Approved By
Application Disapproved for the following reasons'
Permit No
Issued
tjLL
Daf
ll. _L27A
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
hlrrtifiratr of Qlnmplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (
)
Inataller
at
has been installed in accordance with the provisions of :Article NI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTtF'CATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
id ATI-
Inspector
by
THE COMMONWEALTH OF MASSACHL__
BOARD OF HEALTH
OF
Q1 rrtifiratr of (gnmpliaiur
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
at
has been installed in accordance with the provisions of Article X1 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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r
No t to _ OF .--ef'
Ji ptmgl Itiork.i Lnnstrurtiou larrinit
Permission is rehy granted / /• - 411
to Construct ( . Repair ( ) an individual Sewage Disposal System
at No
FEE 12.1 /1
strra
as shown on the application for Disposal Works Construction Permit No
DATE
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS
7
Dated •(1.1
e71
Hoard of Health