Loading...
560 Application & Permit 1998 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .!S OF.NSQFdTNANIPI C. ' F 3pplirntinn fur Di5prnFt1 Ciunstrnrtiun Permit Application is hereby made for a Permit ) or Repair ()c) an Individual Sewage Disposal tem at: to Construct DC of Building Dwelling— No. of Bedrooms Other—Type of Building Other fixtures sign Flow ga ptic Tank—Liquid capacity gal sposal Trench--No. Wid epage Pit No Diameter :her Distribution box ( ) trcolation Test Results Performed Test Pit No. 1 minutes per Test Pit No. 2 minutes per or Lot No. Address Address Size Lot Sq. feet Expansion Attic ( ) Garbage Grinder ( ) Showers ( ) — Cafeteria ( ) No. of persons gallons. lions per person per day.Width daily flow Depth ons Length Width Diameter th Total Length Total leaching area sq. ft. Depth below inlet Total leaching area sq. ft. Dosing tank ( ) Date by Depth to ound water inch Depth of Test Pit Depth to ground water inch Depth of Test Pit P escription of Soil 1 e of epa rs or Alterat onsa Answwe 1 51,0 The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with r wwgetteapplf \greetnent: (1 he provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in >peration until a Certificate of Compliance has a issued the board of health. ��' ' / ry o .G Application Approved By Application Disapproved for the following reasons Date Permit No Issued. Date THIS uuTO C ,JnS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF NURihu1v��'i' Qlrrtif raft of Qlumptiantn TIT«Y, Th t the Individual Sewage Disposal System constructed it � �(:O 4CAM?- f been installed in accordat(ce with the provisions of TITLE 5 of The State Sadintearry Code as described in the dication for Disposal Works Construction Permit No THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE STEM WILL FUNCTION SATISFACTORY. .TE Inspector staler or Repaired (A a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �FN∎frt: I H.Ar.p p Y. 1■ flisxnsal melts Cticau truttimn Permit Permission is hereby granted -./ Dis Construct ( ) or Rwair ( K) anelndivldual,Sa f No e.T�..,�..( '�'t..a':.. V a_ shown on the application for Disposal Works Construction Pe L 1System Fax ATE )RM 1255 P. M. SULKIN}INC.. BOSTON St r D,t4 Hwrd of Health