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Requested by: DEAN LNARQON
OBSERVATION PITS
Lot POOR 5i 10
Date performed: MAY 2 3 1989
Site Location: NOai}+AMpioN MA Registered Sanitarian: Timothy E. Maginnis
License number: # 982
Test pit # 1
ors
SRN• c.oRM
Gime SANt w !2 I
Board of Health: PETER PMER-LAIN-AGENT
3'=23"
a3" 413„
43°120
Groundwater: NON E
Oxides: !V Q N 8
Perc Rate: A.3/0;
Test pit # 4
i
long"
Test it # 2
P.•:.4 tines
H"ALIS- LSPOZS
al" S
Mew.SANG
C4 mpgcTtro
F'NE SANP
fKro.(G,NL serNO
3`- 12
i. b
34."--1024
oz'-123"
Groundwater: NONE-
Oxides: NONE
Perc Rate: SMbN/Ou. a156`
Test pit # 5
Test pit # 3
V t.L wamm3
Mom" ' FA..es
0TS
Met SRN.D
$iL'ty FINE
J Rn)`O
ht 3S
3S "- t3z'
Groundwater: NONE
Oxides: NONE
Perc Rate: Smm a7 z6 h
Test pit # 6
Groundwater: Groundwater: Groundwater:
Oxides: Oxides: Oxides:
Perc Rate: OF Mno Perc Rate: Perc Rate:
No.... Fi--�
THE COMMONWEALTH OF MASSACHUSETTS
BOARDQF HEALTH
Application for flispuual Thurks (ntuitr ati ppermit
Application is hereby made for a Permit to Construct //)
Fes_ D 0
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow gallons
Septic Tank—Liquid capacity gallons
Disposal Trench-- No. Width
Seepage Pit No Diamete
or Repair ( an Individual Sewage Disposal
or Lot No.
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Description of Soi
per person per day. Total daily flow gallons.
Length Width Diameter Depth
Total Length Total leaching area sq. ft.
Depth below inlet Total leaching area sq. ft.
Dosing 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
Nature of Repairs or Alterations—elnswer when applicable .--_ _. ... Lrt.-16`e-eC
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of I. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss ed by the bo' dd of health.
Si ed
0 Oe
Application Approved B
Application Disapproved for the following reasons'
Permit No...2h.k
mm
Issued. /3,.197i
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Cnrrtifirttt• of fdnntplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
at
has been installed in accordance with the provisions of Ti'TLE 5 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.
DATF Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Tispanal Works tIIonstrurtion hermit
Permission is hereby granted-;,.
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
sr-ea
as shown on the application for Disposal \\'orks Construction Permit No Dated
FEE
Board of Health
DATE
FORM 1255 HOBBS at WARREN. INC.. PUBLISHERS