Lot 25 Septic Applications & Permit THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` (in"- OF 41/47-44e7P7P ,)
0 licatAon Marko ratunotrurtirm Vaunt Sewage Disposal
Repair ( ) an Individual Systan at:
FEE
ivracofrg_ Lga.
4inv C047:5Thapu,
owner
Installer
Type of Building
Dwelling—No. of Bedrooms
Other--Type of Building
Other fixtures
Design Flow >0 gallons per person per day. Total daily,ilow •-t -ie)
Le.ti.../
Septic Taabiquid capacity 140 gallons Lengthie LQ' Width5k2.; . Diameter Depth ions.
Disposal No ( Width "70 / Total Length --e'c'' Total leaching area...( )C sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dositx tank L.)
Percolation Test Results Performed byttee4ICalli .i 5,61/1/-tki4lizieY Data 5/it'/ 74-
Test Pit No. ii'i minutes per inch Depth of test Pit..2= /0"Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit 7= G ' Depth to ground water 7- 6'
zs
or Lot No.
Address
Address
Size Lot..Z.4224 Sq. fea.
Expansion Attic ( ) Garbage Grinder (V)
No. of persons Showers ( ) — Cafeteria ( )
Descri ption of Soil 4 -C Leigijz 5 re% 721?&?z.4.- .114›- 43,EA)
Rtilleithirc/7 7P year/P7 E zee G,) a 4-6 " SiC •
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'
Date
Date
Date
Permit No Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
atrrtifirott at atottlytiatta
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 XI 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
'HERE APPLICABLE
CHECK OR FILL
to
t ......... FEE IS 6
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O F HEALTH
OF
Applirutinn for Ui�pnsttal Mork!' Qtutuitrurtinn lJerntit
Application is hereby made for a Permit to Construct (VCor Repair ( ) an India ideal Sewage Disposal
System at:
4,
F.goSoan 'idstX,[
Thaq pity DP.
.I
y`st ac.�//.._C�. Address
Lnsta . Addye.
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms__ _3 Expansion Attic ( ) Garbage Grinder (I
Other—Type of Building No of prrsmn Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow ..Jla ,gallons per person per day. Total daily flow gallon.
Septic T:uil<—Liquid capaci tv(¢66_Ogallons
Disposal Trench—No. Width
Seepage Pit No Diameter
Other Distribution box ( ) Dosing
Percolation Test Results Performed by
Test Pit No. 1../_j minutes per inch
Test Pit No. 2 minutes per inch
Length Width Diameter Del al:.
Total Length Total l e:¢hing arc-. 4Q_d—sq_ ft
Depth below inlet Total leaching are't sl_ ti.
tank ( )
Date
Depth of Tett Pit Depth to ground water
Depth of Test Pit. 71i r Depth to ground water.. 7 d
Description of Soil
Nature of Repairs or Alterations--Answer when applicable
Agreement:
The undersigned agrees to install the afore.
the provisions of Article NI of the State Sanitar
operation until a Certificate of Compliance ha
ihed Individual Sewage Disposal System in accordance with
The undersigned further agrees not to place the system in
b- the boe
Signed
moqt,, y I]ete
Application Approved By �_ .___ ...-.!L_ y�0o� %
1 /9%±
o Wm
Application Disapproved for the following reasons-
Permit No._Ur
Issued
by
at
r _/AZ-Se-Sit
THE COMMONWEALTH OF MASSACHUSETTS
(( BOARD OF HEALTH
OF f)f .:1AL' lrA'
en-filtrate of fllomplittnrr
THIS IS-T9 CE1'CI1J TII k tF e-dndividual Sewage Disposal System constructed ( F) or Repaired
ms I
has been installed in accordance with the provisions of Article XT of The State Sanitary Code as described in the
application for Disposal Works Construction Permit rmit No (�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE
SYSTEM W1;1 FUNCTION SATISFACTORY.
1y dated %k'- _If, ./Q%S
CONSTRUED AS A GUARkNTEE THAT THE
DATE � fi � . e 1975..
No
Inspector_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF (.
r ' t
� r
�isposttl iliorlts hioustrurtiuu Permit
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No r-°s
Sm-rt
as shown on the application for Disposal Works Construction Permit No Dated
FEE
Boa fl of IloaltI
DATE
FORM 1255 HOBOS & WARREN. INC_ PUBLISHERS