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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,