157 Septic Application 1993 CHECK OR FILL IN WHERE APPLICABLE
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Crry OF NoRritri&ya s/
pptiratiun for Uispusat Murky Cnonutrurtiun lJrrmit
Application is hereby made for a Permit to Construct
System at: i ELD
cr1.EST.�iZF
Qt et
Installer Address
Size Lot Sq. feet
Dwelling—No. of Bedrooms y2 Expansion Attic ( ) Garbage Grinder ( r
Other—Type of Building _51N6.....rIPM.. No of persons x___________________ Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow ,E.Jr gallons per person per day. Total daily flow 33.0 gallons.
Septic Tank—Liquid capacity rad gallons Length.L.7. a' Width_ 0' Diameter Depth.iiL.°
Disposal Trench—No Width Total Length Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing to (a Z /pR 61NNIS �j-4
Percolation Test Results Performed by twl 77 Date
Test Pit No. I t minutes per inch Depth of Test Pit....ia " Depth to ground water .N/A
Test Pit No. 2 minutes per inch Depth of Test Pit f,, Depth to ground water
Description of Soil an - aS.lg.860f4-- - MA-0.._t..&T.R.. (-
Type of Building
(V) an Individual Sewage Disposal
sr HARDINEr /SI GHrankr sto /tagm
tt9±10 .1(ttaLS
Nature of Repairs or Alterations—Answer
S Arc. when applicable &eP E 5Li& TttttoRRQ
Plw9Mi VSTEM C..ES.Spaal
Agreement: -�
The undersigned agrees to install the aforedescribed 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 board of health.
Application Approved By
d.
Application Disapproved for the following reasons•
a---- sJ.l. 1. 13
Permit No (..
Issued.
Date