243 Application & Permit 1973 k..C.7
FRE. J. L:'. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
etOF /./c-i.{_-
Apptiratinu for Dinpnsttt Mirka htnnstrurtinzt Permit
Application is hereby
stem at:
pe of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
{
made for a Permit to Construct (Yrcil Repair ( ) an Individual Sewage Disposal
i pss
.. . .
o Address
f
Installer
e
or Let No.
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
:ign Flow gallons per person per day. Total daily flow pgallons rtic Tank—Liquid capaci gallons Length Rid l Diameter llcth
posal Trench—No Width Total Length Total leaching area/00.asq_ ft.
page Pit No Diameter Depth below inlet Total leaching arerl sq_ fl.
ler Distribution box ( ) Dosing tank ( )
colation Test Results Performed by _ Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
cription of Soil
ure of Repairs or Alterations—Answer when applicable
eement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
ation until a Certificate of Compliance has been issued by the yard of healtl
Signed
Led I
<3 I) to
dication Approved By
' ' __ ..:71 .. '✓aytL : �,p a..,.((�..i9JJ1
Dae
■licttion Disapproved for the following reasons-
Permit No_e_L. 7
Date
Issued. . t-.1--,_J 92
Dam
THE COMMONWEALTH OF MASSACHUSETTS ------
BOARD OF
HEALTH
C-11
OF
Crtifir
of (IIottiilittttre
THIS-L5TO CEPy",r[FY, Th Indivdual
Sewage Disposal System constructed (/ or Repaired (: r At Ot
r./ 3 "c4..4. f-e`-,w-
Installer
been installed in accordance With the provisions of Article RI of The State Sanitary Code as described in the
■lication for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
STEM WILL FUNCTION SATISFACTORY.
T .c, 10, I.9 7-3
Inspector.
4 % 4044-#ea-i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF rt °kpI` ..
+ ' v
REED-r (1 f%
anted . - ork atop rt tirrntit
Permission is reby granted �,. -.-'t,. 11>
.onstr Ct 4 epair ( ))yn Individual Sewage Disposal System
Iowa on the application for Disposal Works Construction Permit No /7 %/!l
Dated
( f, ,./ =PM
1233 HOBBS B WARREN. INC.. PUBLISHERS
// / 1t3
Board of Heald,