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47 Application & Permit 1982 10 No.e — ?1 FEE./e_ry THE COMMONWEALTH OF MASSACHUSETTS BOARD OFLTH OF � t Appliratinn fur Elinpnsttl 'o arks Qtunstrurtinn hermit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: if? GIddw TAA .......A at w " lai-t drss" (� rAt a u, . Address I oxtalle Address 6 Type of Building Size Lot Sq. feet Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building No. of persons Showers ( ) — Cafeteria ( ) a. Other fixtures 6 W Design Flow gallons per person per day. Total daily flow gallons. W Septic Tank—Liquid capacity gallons Length Width Diameter Depth 2. Disposal Trench—No. Width Total Length Total leaching area sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area_ sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date jTest Pit No. I minutes per inch Depth of Test Pit Depth to ground water W Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water c4 0 Description of Soil g W U Nat re of Repai s or Alte ations—Answer when a icable .. i A eement: The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 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 .oard .f h h. //' ---k-Si • d .. 4 e.: ..... /. wi OatgG Application Approved By �fi` '/ _. , oAwD7 Application Disapproved for the following reaso - S Date Permit No c),..y] /7)— Issued rifaltD-- n by at '5/ 7 14J.%-4- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a� esq bbed in the application for Disposal Works Construction Permit No 1�..3 -g 1' dated F/01/8- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF tT rrtifiratr 4 Qinmplianrr THIS IS TO CERTIFY hattIt�y�tt��vtd�p�a� Sewage Disposal System constructed ( ) or Repaired (t3— n/_e/1/L SYSTEM WILL FUNCTION SATISFACTORY. DATE ?rAls iPJ` Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF f., rw No a Oispnsal i mho fount inn rrm Permission is hereby granted to Construct ( ) or Repair (1. an Indiv' u a Dt+ stem at No 7U Street as shown on the application for Disposal Works Construction Permit N DATE 17-.Y {g.'et. FORM 1255 A. M. SULKIN, INC . BOSTON don FEE"C y`LI /D$ted , .,11 of of Health