247 Septic Application 1986 LL IN WHERE APPLICABLE
CHECK OR
No3N-8_'k
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Fza/ t«. "1,,,,
4.0kA 17T CITY - . -oF NORT.HAMP.tO1+1
Appliratinn fur Buipagal i'ftnrks (germination tirrmit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual See
System at: e,,erpq.*u *, ,,,:
ca.LE..:.S MEAOow RD. Lo.r
s m �t ,o.
Jo jE.P.a \rre aFk ERI_JR. 2.47 COLES..I1AEAD.aw
Type of Building
Dwelling— No. of Bedroom
Other—Type of Buildit
Other fixtures .
Design Flow
Address
Size Lot t'i.34..Q.L.?...Sq. feet
Expansion Attic ( ) Garbage Grinder MO
No. of persons Showers ( ) — Cafeteria ( )
55 alions per person per day. Total daily flow 330 REA.)-9ISAY4,gallons.
Septic ic Tank—Li 9 vid capaci , _ hs Leng[h...8.5 . Width.. a s Diameter Depth 51
Disposal Trench--No .3 W iaflh ZL Total Length l3$a Total leaching area__ 3.5 sq, ft Si DES
Seepage Pit No Diameter Depth below inlet Total leaching area 270 sq. It STM
Other Distribution box Dosing tank ( ) `Percolation Test Results Performed by F A. L_Ilf_�5 Date MA(( $t Ilk
Test Pit No 1 6 :situates per inch Depth of Test Pit /0 7" Depth to ground water 83"
Test Pit No. 2 minutes per inch Depth of Test Pit. /0.2” Depth to ground water. Es"
Description of Soil ENG.LO-SED
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=L_...: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliant as been issued by the board of health.
Application Approved By
Application Disapproved for the following reasons'
Permit No
Date
Issued
Date