Lot 7 Septic Application & Permit CHECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
PEE
BOARD OF HEALTH
*L4 OF tin[/!lFIn,}r-vi
Application for Uispusttl Marko &inanition lerutit
Application is hereby made for a Permit to Construct (Kor Repair ( ) an Individual Sewage Disposal
System at:
2 Y?�t, ,.. iw
or Lot rro.
;4t�te� °4.
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Address
Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 1 J gallons
Septic Tank—Liquid capacity! gallons
Disposal Disposal Trench—No. Width
Seepage Pit No Diameter
Other Distribution box
Percolation Test Results
Test Pit No. I 2r
Test Pit No. 2
per person per day. Total daily flow 3 6 d gallons.
Length Width Diameter Depth
Total Length Total leaching area sq. ft.
Depth below inlet Total leaching area sq. ft.
Dosing tank ( )
Performed by Vi. .` Y . .... Date
mnutes per inch Depth of Test Pi Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersined further agrees not to place the system in
operation until a Certificate of Compliance has
Application Approved By 9zt FF i ! ,nS e
71i..
Application Disapproved (or the following reasons'
Permit No._1..�..1
Date
Issued ./k`4 .1 Oy /941
Dale
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF. CI
ertifirute of Olnthphttnre
THIS IS TO CZATIFy, That Ss I diyi ual Sewage Disposal System constructed ( ) or Repaired
by t!n ) I divAL
at
has been installed in accordance with the provisions of Article XI of The State Sanitary C de as described in)he
application for Disposal Works Construction Permit No I 1 q dated Ja2,z ../.R .�l.F-
170.11
4
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. . . '/
DATE i y ....i.K., 1.1.i Inspector... �.....ttLiClt `.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
// � � L
No 17 / . . . FEE
Othpuntt Norio' f qu traction Vrrmit
Permissiorrtierehy granted
to Contra ) or, Repair e an to ividual Sewage Disposal System
LtdikaL 1
at No .._. ....... .. ✓.gun Cv../ �
Street p
as shown on the application for Disposal Works Construction Permit No 1 7 / Dated_L
J > 1
Beard"ef (teal
DATE
FORM 1255 HOBBS & WARREN. PUBLISHERS