Lot 9 Septic Appication Permit & Plans CHECK OR PILL IN WHERE APPLICABLE
No 73 0 Fna/,_�... 0.0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratintt for Otapaual Marko Tuostrurtintt Pruitt
Application is hereby made for a Permit to Construct (V) or Repair ( ) an lndn idual Sewage Disposal
System at: A itti
An ja ddr¢ I rLot 60.
firtgaal
__ r
Itvttallev ALdoess
Type of Buildin Size Lot Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of parsons Showers ( ) — Cafeteria ( )
Other fixtures .................................................... .
Design Flow___ ___. _ Q _gallons per person per day. Total daily flow 300 gallon-.
Septic "1:ink--Liquid rapacity a gallons 1 ength Width Y Diameter Depth
Disposal Trench—No. AAridth..aOI Total Length..3d Total leaching aren._4g6 eq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sitit
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. I minutes per inch Depth of Test Pit. 6 - Depth to ground water_Zfr20T-Q
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water _
Address
Description of Soil _
Nature of R cpairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article SI 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 thee boarr(dd oft health.
ed` .zrt� r4a.t,, tc.
Si�� 'L e , ..4
Application Approved By
Application Disapproved for the following reasons'
Permit No 3.0
Data
Issued 91fr W__�l,_..1974
m
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(tlertifirtttr of Qluntolianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
IDs been in stall cd 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 CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
CHECK OR FILL IN WHERE APPLICABLE
No F
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CI y OF Nar/Aamp%n
.Appliratinn fur f3- inpnsal urkn Clinnstrurtinu Vrrut
s
ASP
F' MILES 3.
HUd t1=+i
°a 20023 LER 4l'
Om_ LS7E ‘C'C
t.M..RF...y��
sS/ONAL
Application is hereby made for a Permit to Construct (A ) or Repair ( ) an lndilidual Sewage 1h posal
Sy tun at:
cn�9n . naaaa, 46,4.4( 4E4 7
or Lo: No
,CQberf....5 Pail eh' %...lea!zckI.A...e....Eas A nip.Ln 4114... O/c27
Owner Address
Installer
Type of Building
Dwelling— No. of Bedrooms
Ocher—"type of Building
Other fixtures
Design Flow 3t 1171,0 gallons per person per day. Total daily
Septic T:uile—Liquid capacityCliCgallons Length Width
Disposal T '- "'__Fl e 14'..... \Cidth__18. .___. Total Length
aa./
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tanyk�( )
Percolation Teat Results Performed inch Depth ..s.g-.i<. � _. Date 5- 25-73
Test Pit No. I 2- th of Te. 'it_._6,.Q t Dept I to ground wute- Done
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Address p
Size Lot../.5-8 75 Sq. feet
Expansion Attic ( ) Garbage Grinder ( yeS
No. of person- Showers ( ) — Cafeteria ( )
flow 3.0.0 gallons.
D inmeter Depd• i0_6-'
Total leaching area ..3 .sq. ft.
Total leaching area sq. It.
Description of Soil St.�1 £ If CICeL---�7.2.}C SoLL Q —.Sc' 3911 d._Sk(t_(e,osc
" 6,C " f2f'.._San d_. Q! M.L. /aa:i e
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 NI 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
Date
Date
Date
Application Approved By_
Application Disapproved for the following reasons'
Permit No Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
hlrrtifiratr of tdnmplianrr
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 NI 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
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