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625 Application & Permit 1987 No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tt OFNORTHAMPirTh ... _ . . Fax 1 r .e.–OSL )pplitutiun fur fliupuuttl iflurks Tunutruttiun lrrmit Application is hereby made for a Permit to Construct ( ) or Repair (L/C an Individual Sewage Disposal System at: Type of Building Dwelling— No. of Bedrooms Other—Type of Building Other fixtures Design Flow Septic Tank—Liquid capacity -Disposal Trench No. Seepage Pit No Other Distribution box Percolation Test Results Test Pit No. I minutes per inch Test Pit No. 2 minutes per inch or Lot No. Address Expansion A Address Size Lot Sq. feet c ( ) Garbage Grinder ( ) No. of persons Showers ( ) — Cafeteria ( ) gallons per person per day. Total daily flow gallons. ca gallons Length Width Diameter Depth Width 'fatal Length Total leaching area sq. ft. Diameter Depth below inlet Total leaching area sq. ft. Dosing tank ( ) Performed by Date Depth of Test Pit Depth to ground water Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or Alterat _trap Agreement: The undersigned agrees the provisions of TITLE 5 of operation until a Certificate of Application Approved By Application Disapproved for the following reasons' ns— swer w en a Ipp icable o install the aforedescribed Individual Sewage Disposal System the State Sanitary Code—The undersigned further agrees not to Compliance)as been is ed by the oard of he in accordance with place the system in Permit No Issued_ Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 oF, Nljc;,7 HR IV T' Oirrtifiratr of Qlompliattrr THIS I O TIFY, h i• e IndividuaLSewage Disposal System constructed ( ) or Repaired (/� by !g, a II��,+11 - { m.mner at (pas IsSLT�'"_/'s f (r has been installed in accordance with the provisions a TIT I Sep he State Sanitary Cod desc to the application for Disposal Works Construction Permit No o / dated r. ..d THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED S A GU;. N T THE SYSTEM WILL FUMCTION SATISFACTORY. DATE No -Dsdi /2 Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OFS . . _ .. . . . . ..... Disposal cr; orbs «Cpnsirurtion tirrmit Permission is hereby granted to Construct ( ),or,Repair ( '') at IndividtTl Sewage Disposal System at No Nye Street - . . as shown on the application for Disposal Works Construction Permit No Dated Board of Health DATE FORM 1255 A. M. St1LKIN, INC., BOSTON