Lot 24 Septic Applications & Permit Sew
air
age Y ( ) epa age Disposal
System P a /E /11571.41;i1/ 4.444.1-5 ////f 742"4-or Lot No.
42!?_L co i `TR�ie1T/ajl/ �iU4.' "".7°n�[
Owner Address
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C/i Y oF. Alae7//A7nti'70n/
Appliratiun far flispunal ifl!ark (nnnotrnrtinn lrrmit
lion is hereby for a Permit to Construct ✓ or Repair ( ) an Individual
CHECK OR FILL IN WHERE APPLICABLE
Installer nnar.a
Type of Building Size Lot t 6 d-0+ Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (
Other—Type of Building No of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 0 gallons per person ppp��eerr day. Total daily flow a 0 0 gallons. i
Septic Talk—Liquid capacity(Z. gallons Length /0-a Width s=p'r Diameter Depth .51--4-'
Disposal Treri No. L Width Z.P' r Total Length -..". <:) r Total leaching area /r'00 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( _) /Percolation Test Results Performed byX. . ....Z .Glpi%'5/^ /N-4i 7t r.Y Date 5,[..72? ..Z4
Test Pit No. 1 -- . : ..minutes per inch Depth of Test Pit 4"t-6 n Depth to ground water �Ai°4).5
Test Pit No. 2 minutes per inch Depth of Test Pit 71-1:2 Depth to ground water .55 'C?-`.1
...
Description of Soil.._f
o f/t1/ 5.44tio_/ G r/OACe. 5d.✓A..y Z q .r
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.
Signed
Application Approved By
Application Disapproved for the following reasons:
Permit No
Date
Date
Date
Issued
Date
L IN WHERE APPLICABLE
No.... 73
THE COMMONWEALTH OF MASSACHUSETTS
jj /ABOARD OF H HEALTH
,�
Appliratiau far((11 iiispasul 3 urks QIaustrurtiuu Permit
F � y^ 0L F„ J
Application is hereby made for a Permit to Construct or Repair ( ) an Indiaidual Sewage Disposal
System at:
1711.4464144 '01 or Lot No.
Address
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms eg Expansion Attic ( ) Garbage Grinder (' r
Other—Type of Building No. of persons Showers ( ) -- Cafeteria ( )
Other hxtures
Design Flow S4 gallons per person per day. Total daily flow gallons.
Septic "rank—Liquid eepacit0.5 1 gallons Length Width _- Diameter Depth
Disposal Trench—No. AA idth Total Length Total leaching area (Od_sq. ft.
Seepage Pit No Diameter Depth below inlet Total leachiug :ire:: w/. fu.
) Dosing tank ( )
Performed by Date
MI notes per inch Depth of Test Pit Depth to ground wan
minutes per inch Depth of Test Pit Depth to ground water - -
Other Distribution box
Percolation Test Results
Test Pit No. I . 3
Test Pit No. 2
Description of Soil
Nature of Repairs or Altera
sns—Answer
len applicable
Agreement:
The undersigned agrees to install the afor
the provisions of Article AI of the State Sanitary
operation until a Certificate of Compliance has b
Application Approved By
Si
ihed Individual Sewage Disposal System in accordance with
agrees not to place the system in
The undersign
by he boar
/9.LZz
m�(
Application Disapproved for the followin reasons
Permit INto.-. .73
Q pD Oath
Issued //L -I f, Lfyr
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(4( t OF 1/ r�.
T ,
rrtifirate of alznmptianrr
THIS ?Sy CE CI Y- tike Individual Sewage Disposal System constructed (�'1 or Repaired ( )
by at Sir 9 F lit4:7440 t r.ahr
_ iN�..
has been installed in accordance with the provisions of Article XI of The State Sanitary de as described in the
application for Disposal Works Construction Permit No —3 dated_..7't!tt / Jfls
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE �_ �. Cg J-# 7, Inspector 44 iz...c,votimen,
No 4, I
THE COMMONWEALTH OF MASSACHUSETTS
j
BOARD OF HEALTH
/
OF
Univocal Marko Lanstrnrtinn Permit
•Permission is.hereby granted. ' — h��'
to Constri ( t ) oy Repair ( ,4.a+i Individual Sewage Disposal System
at No
FEE.z.
Street
as shown on the application for Disposal Works Constroctic7
i
permt Nom-L Dated_
DATE -
FORM 1255 HOBBS a WARREN. rNC.. PUBLISHERS
Board of Health