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88 Application & Permit 1993 L t) Sed. pi,. z.��n.. - 30 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I v OF NcRTri te.2Jtest Appliratinn fur illispusul Works Cnnnstrnrtiun e Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual at: S-e-t_✓<S 7Th S,0/3.b _ Location-Address or Lot No, 0MOrK}en^tL // ..13E1K.F-iz /Rug.r�e)f S,,;W��pipRI \,a,,,�' t g� C1Ci.. 90 lid 44l II, &Ilea t� T Address Instal er 1 /C 6 1)(C. r r, f�� 4 Type of Building Size Lot v Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (A/O) Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) Other fixtures ti O gallons. Design Flow .-r gallons per person per day. Total daily flow Septic Tank—Liquid capacity_ 5c )gallons Length t " :1 Width_ _6)- Diameter Depth_5 ,_y.. Disposal Trench—No. 3..----- Width -0 Total Length /36 Total leaching area_ ...7 2-6 sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box (') Dosing tank ( , ) Percolation Test Results Performed by �4CL i, 4S5O(--;5y.C5 Date n��/t" `3i I �� y Test Pit No. 4 6 Z minutes per inch Depth of Test Pit /66) Depth to ground water 7 Z Test Pit No. 2 1 ' minutes per inch Depth of Test Pit //4-.. Depth to ground water PSI' Description of Soil PcE, s/5.7 E,47 SGPAe- 5Y1 Tr.r Pe,}rI FoZ 7aSi Jxir .S etc, 0 gS/PPnvS . 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 TITLE 5 of the State Environmental 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 1- /s Application Disapproved for the following reasons: &w rd/0 tom+_(!plc ' Permit No. _ _ Issued nitt THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA ;TH OF _. . > 1p Certificate of Compliait ndivA al Sew e Disposal System constructed ( ) or Repaired tcerke has been installed accordance with the provisions of TITLE The State nvironmental Code as c}escribed in the application HE ISSUANCE for Disposal THIS Construction SHALL No 3D—I dated Ll ./ jr THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAFFFEE THAT THE SYSTEM WILL FFUffff�111CTT ON SATISFACTORY. } ,°b& DATE S.NI , ..1,5—, Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'Uo t L.,14 Lr 12 0+ arlm Qtnq{ trur'tt tt lrrmif tv t, Ka.t4.L-...- -. . OF 3iupuSat iDG Permission is hereby granted to Construct rP Repair' (m an 1p at No .yi u ' III: Sewage Dis sal t LA Syst � I t L je. L' J=am Date as shown on the application for Disposal Works Construction Perr1--- oard of Health �So ` ,149/5 Y Gt FEE..L DATE ct FORM 1255 X95 HOBBS & WARREN. INC.. PUBLISHERS t