31 Septic Applications Permits & Compliance HERE APPLICABLE
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Application fur Piipanal iflurlt Totwtrurtinn tirrntit
Application is hereby made for a Permit to Construct ( ) or Repair (V) un ludic ideal Sewage Disposal
System at: '4-
Locatti cidress or Lot No.
r
sari
n.=urer
Type of Building
Dwelling—No. of Bedrooms
Other—Typ of Building _ No.
Oth r fixtures
Design Flow gallons
Septic 'r uil<—Li Inul capacity f,aI! 'ns
Disposal Trench—No Width
Seepage Pit No Diameter
Other Distribution box ( ) Dosing
Address
Addres
Size Lot Sq. feet
P spansion Attic ( ) Garbage Grinder ( )
scats Showers ( ) --- Cafeteria ( )
per person per day. Total daily flow gallon-
Length
Width _. Diameter Del tl- _..
Total Length Total leaching are sq ft.
Depth below inlet Total leading arc s IT
tank ( )
Performed by Date
minutes per inch Depth of Test Pit_ Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Description of Soil
Nature of Repairs or Alteruions—Answer when applicable
ate_ can, 300
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 i-sued by lh ealth.
Signed
Application Approved By
Application Disapproved for the folio
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Dnte
sons.
Permit No..yl.f.p
Issued 4.e. 02,.117-c
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFT�-- }
HEALTH
Ciertifiratr of Olnmplianrr
THIS IS-3-O CER�"f�F,Y, That.the Indivir al Sewage Disposal System constructed ( ) or Repaired (r)--
by Installer
at .'
has been installer) in accordance with the provisions of Article RI of The State Sanitary Coe as described in the
application for Disposal Works Construction Permit No 6-9-7 dated > L G-=2, .11 7.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.SATISFACTORY. /�- .� r� {:
DATE ait-rwr A i/ 7 Inspector_�_S?�}L-art-t:. -`3�'i• -�
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.. -7 7� - n
Tisposa!-%urks &ins ton 1Jrrmit
Permission is hereby granted 0'
to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste
at No
street
as shown on the application for Disposal Works Construction Permit No r Dated
FEE :1u
Uo rfl of Health
DATE... _.. .FORM 1255 HOURS B WARREN. iNC.. PUBLISHERS
Nu.../C 9/
THE COMMONWEALTH OF MASSACHUSETTS
//�� l /BOARD, OF HEALTFj
1. )%T of /vo, 'i!/{'%%',�'�.
Appliratiou for 33isposui Mirka Cnonstrurtion 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
r kl 0L ecamn-Add /s
w
a
C Type of Building
.U. Dwelling—No. of Bedroom
a. Other—Type of Building
W Other fixtures _
d Design Flow
W
a Septic "tank—Liquid capact y
W
x Disposal Trench--No.
3 Seepage Pit No Diameter
Owner
0
Installer
./
fr} :enn. �.
Address
ddress
ize Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
lions pe erso ? Total daily flow gallons.
314s-l/ ength t Wi Diameter D n
idth n1 Total Length ... Total leaching area_ -sq. ft. pa
Depth below inlet Total leaching area sq. ft.
Z. Other Distribution box (X) Dosing tank
Percolation Test Results Performed by r
-q Date S/aC/2L_..
„aj Te+st' it No. I p}(1_minutes per inch Depth of Test Pit .:./ Depth to ground water r.„5- r
{y '���eSt�it No. 2 minutes per inch Depth of Test Pi t Depth to ground water yy (/Jw-�/N
W Description of Sod -1<. t{__••••• t.' +�- {�sL2 i'e2 ... . l: �SSi o'i� fy(;Yl/G4rib
w i1cSt�> fs / AS�=t3 cl v /h a�.a'rT l 1� lk
UNature of Repairs or Alterations—Answer when applicable eL-(. c 6-
L-Cie-Krrvc -2ttren's /`
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in
the provisions of:1TII 5 of the State Sanitary Code— The undersigned further agrees not to p
operation until a Certificate of Compliance has be; issued b the board of health.
Sign ...Alit-
Application Approved By
Application Disapproved for the following reasons'
Permit No
Date
Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD A� HE TH
Cilrrtifiratr of Tampli rr
THIS I CEIZIFY, T . the Individ,.l Sewage Disposal System constructed ( ) or Repaired (k)
at 3/
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as des ribed in the
application for Disposal Works Construction Permit No /Ii —9( dated V. 5.
0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL
✓� OF
�is}�nsttl nrks @innstrurtinn jrrmit
Permission is hereby granted
to Construct ( ) or Repair (c/)_
at No .t.._y�n.. ,�
as shown on the application for Disp
(vi.u4., �-'
an/Individual Sewage Disposal System
`-s l 77/-r-r-
\- Street
osal Works Construction' Permit No/f/. . -./------ Dated
DATE / ssl�'
FORM 1255 KOBE'S a WARREN. INC.. PUBLISHERS
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