Lot 33 Septic Applications No
Cur
Uuvt
ti15Z
Application for Diopotial
IN N HI.RY.APPLICABLE
0
6
THE COMMONWEALTH or MASSACHUSETTS
BOARD OF HEALTH
(°. 7 v OF .vu..,7u,b er'
Application is nerri '_....1�
System at
(.c.r4 E.VC r
Mm
L.seek,
Type of Building
Dwelling - No. of Redrooms
Other--T.pc of Hnildhtg
Other hztu. -
Drage rlow e. " - I peter.. per day Total daily flow
�`ac.._I - rrnd h1 Cn "city _.4allon Length Width Diameter
D+ ___ Kidth_ .. Total Length
Seepage . It Ni) . P+ame er.__. -. 'Nigh below itdet
ank
irkli Lulllitrurtimt VVPrplit
t f 1 or Repair ( ) au Lulu ideal Sewage
Disposal
'33
Admen
Address
Size Lot .74.net-"e t sq. feet
_. Expan.ion Attic ( ) Garbage Grinder ( )
of persons Showers l ) -- Cafeteria ( )
gallons.
Depth
Total leaching area sq. ft.
Total leaching area sq. ft
Other Distribution box i 1 Dosing ( ) /4.1.4,7c4 ,E.erG.P
- , ✓//fie 7 y
ints:Test Test . :tall Performed r ler .C 2 _S" Depth
D ra�Test i'it \o. . 2.G._ + n � i✓r 'x Depth of Test Pit
N 2 Ininrnes per (tell Depth of Test Pit.7.-Qa. Depth
Date 4y-Nf/-7/
to ground water.HO.K eCt
to ground water.
Description of Soil.?' -04011 --/.L.4`..f:',F..J..f 3`flNte CNC JA.vo trycl-
DE$EZ .A70 C_E:. 7 -4_:'_. ...._4t'o. uJ •/476 P 3 y"
Nature of Repairs or Alterations—Answer when applicable
Agreement:
-Phe undersigned agrees'to install the aforedecribed Individual Sewage Disposal Sy trm in accordance with
the provisions of Article NI of the .bta)) Sauit ry G de — The undersigned further agrees not to place the system in
operation until a Certificate of Compliaace has been issued by the bard of health
Signed
Application Approved By _. ...
Application Disapproved for the follounsg red
Date
Date
Date
Permit No Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
No Ras
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C /TY of Ai0R.Ttlgre? pi- At
Application for Ilinlfnnal Marko Cnnnliirurtinu llrriuit
Application is hereby made for a Permit to Construct
System at:
5 °8FN c
Location.Address
aL.F t21/.t€�:.T
Ro
Installer
or Repair t ) an Individual Sewage Disposal
33
or tot No.
2..Z.3 /`2,reo.:sa..le/ Sr. /1/49a.a.
Address
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons
Other fixtures
Design Flow
Septic Tank—Liquid capacity
Disposal Trench—No.
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosin. tank ( )
Percolation Test Results Performed by - Nuiv/'CRY
Test Pit No. I 2....14 linutes per inch Depth of Test Pit...7 �+
Test Pit No. 2 minutes per inch Depth of Test Pit
Address p
Size Lot_,�4i0 4'4 se feet
Expansion Attic ( ) Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow
gallons Length Width Diameter......_..__.
Width Total Length Total leaching area
gallons.
th
sq. ft.
Total leaching area sq.
/IJrCL Date...*//_4'/.%/
Depth to ground water._!`—
Depth to ground water
Description of Soil r L....GlI.M� f 6 " '�-!-c.�......s I- 3 :��'QY f/irk
-57:1-al.;?.tr .S/,LT
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 NI 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 reaso
Permit No
Date
Date
Issued
Date