Lot 23 Septic Applications CHECK OR FILL IN WHERE APPLICABLE
•
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C t ry or /VcncrifrMfr> T
Appliratinu for iinponal Thnrkn Q uiuttrurtinu Permit
Application is hereby made for a Permit to Construct
System at:
Fc oigisr/v c c Ro. 23
.77 B4-.8uvirc:r-
Location•Address ov Lo[
Owner
(
or Repair ( ) an I liry idn:d Sewage Disposal
Address
Installer Address
Type of Building Size Lot._.4 el 00 cq feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tarts ( ) (./ ,/
Percolation Test Results Performed by..a%..-/.�-fit T" "Awn, YO As,51ia, Date....7.- �5._f..%i
Test Pit No. l.�c.7.._minutes per inch Depth of Test Pit 7 Depth to ground water..2."-- Co ee
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil O .. 7 .. Ge..QL9.M�, /C/c"e GTLG.T/ 54 1"-5-1# frFRy F//Kg:
S.0 A/42 t a.1 C7—
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 1I 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
Oath
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
471 OF Naer/IAniP7d4i
Application for Mayon( Mirka fknuntrurtinu Punta
Application is hereby made for a Permit to Construct ( ) ur Repair ( ) an hedisidual Sewage Disposal
System at:
Z.3
or Lot No.
..Cd3 /y1 Qprse s7 F<aenu"C
Installer
Miter's
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Plow gallons per person per day. Total daily flow 8a llons.
Addren
Size Lot 4. 9021 eq. feet
Expansion Attic ( ) Garbage Grinder ( )
Septic Tank—Liquid capacity
Disposal Trench—No. Width Total Length
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Prformed by...,l &2.fT riat[Z6fl
Pone. Test Pit No. l. 4.7.3 me.utes pe inch Depth of Test Pit. /■ "
Test Pit No. 2 minutes per inch Depth of Test Pit...1 e-O
gallons Length Width Diameter Depth
Total leaching area sq. ft.
Total leaching area sq. ft.
442a;C... Date...IV-4( /
Depth to ground water-"t '
Depth to ground water Z. -Co"
r
Description of Soil 0-9"<at.r.M;' i'-io�� Ji-7 g_-.t../G2:y.Fes'.E rrir.o ei,t-it7
DdfS.P...1k2GE 7-e" G.Yg.bd K'R7'C Cr).._i'=G "
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to instell 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
Issued
D:n.
Dale
Date