Lot 27 Septic Applications & Permit No.--73.Q....._.. H,,,./-S—Q 0'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ventete,,
Application -for +- i'pnnall iflorkoCo mtrnrtion Permit
Application is hereby'made for a Permit to Construct (/ )or Repair ( ) an htdi■idual 1ee:age Disposal
System at:
/7 ,r , er
he - o1
Instatter
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms-3 Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No of persons Showers ( ) — Cafeteria ( )
Other fixtures
Deign Flow D -gallons per p rson per clry. Total doily Itow 30 .
Se. Ice Tank—Liquid capacity �QQ .Ions length Width D tmict r Dr tl-
gallon-
Disposal Trench- No Width 441 Total Length. 30' - Total lead mg OrtIt_-60 6 sq. ft
Seepage Pit No Diameter Depth below inlet Total leaching area._. - sq. c.
#or tnt
Other Distribution box
Percolation Test Results
Test Pit No. 1--3
Tent Pit No.
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground tt strr 6.a
minutes per inch Depth of Test Pit Depth to ground toter
Description of Soil
Nature of Repair Or Alter:
v
Answ
rhea applicable
Agreement:
The undersigned agrees
the provisions of Article NI n
operation until a Certificate of
o install the atoredescribed Individual Sewage Disposal S ;em in ace nee wit!,
h tote S,Init cry Code . The u ndcssignecl further agrees not u, place the system in
Compliance has been issued by the hoard of health.
.-:
it ry' '1 1%1976
Application Approved 113
Application Disapproved for the folic
Permit No
73r
Issued
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Trrtifiratr of (Compliance
THIS IS 70 CERTIFY, That the Individual Sewage Disposal System constructed ( 1 or Repaired ( )
at
has been installed in accordance with the provisions of Article NE of The State Sanitary Cade as described in the
application for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERT!FlCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATF
Inspector
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
infiltrate of fllomplitturr
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
No r�-i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_�. OF f 1r_,-7114 rr 171)
flinpm al %linrko (Ennntrurtinn lrrmit
Permission is.hereby grantedd d'-- LLU-E
to Construct ( ) or Re it ( ) an Indivu(ua1 Sewage Disposal System
Street
as shown on the application for Disposal Works Construction Permit No r`+ Dated
t
Board of Thrall,
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS