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255 Septic Application & Permit 1999 UiECK OR FILL IN%%HERE APPLICABLE 619 Nn THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE/�ALTH C27 or ll(ItYl<Lr.({•IL [yN Appliratinu fnr Biannual i!Qnrks Qinnsirurtinn Paint Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 256 C'ler h7orj m. R ) �,,' tanwa•Anna 6ae. —i1.4r r'.,e,, 7_ o..., Of Mt NA -J-:saw wee.... Type of Building size La. 4n Of90t' Cq, (¢[ Dwelling— No. of Bedrooms.. �{-)cr a ._Expansion Attic ( ) Garbage Grinder (N) Other—Type of Building ..._._.—._.._.. No. of persons.... _... Showers ( ) — Cafeteria ( ) Other futures Design Flow.--6.5—..._...._.__,.gallons per person per day. Total daily flow_ .'SC ,�—___gallcuss Septic Tatb— !_iquid apaciry%.'.i.2..gulluns LengthZQ.L_.. Width$___.... Diameter.._ thSf_& / Disposal Talakig— No. 1.-... Width )7' _...Total Length..9-O .Total lathing area YCQ.q. ft. Seepage Pi[ No Diameter..........._._.... Depth below inlet_ . Total leaching area __..__sq. ft. ) Other Distribution box ( Dosing pkik (I) qq / Percolation Test Results Performed by .ez.2ezuz t /r m G(*. Date 422_7. � minutes per inch Depth of Test Pit..g. .. Depth to 4 t Tea Pit No. 1 < cap ground water Test Pit N u. 2..._.....__.minutes per inch Depth of Test Pit..—_—_.. Depth to ground water _ Description of Soil...._..........aaLtir2� .PcNTD Nature of Repairs or Almruiuns—Answer when applicable �Lr RTr1.3L.htF�._.��z4�r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prorisiou. 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 ban sawed byy the boar t pf health. Signebte. Application Approved By......._.._....._...._._......._._._..— Application Disapproved for the following reasons. Permit No....—. Iacu,.t Ova Dom THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTH { OF /r Llrrtif irafr of Canny nrr by. THIS 1.} TO lij'jT)NThat t Individual . 7t.gi is Sy;tsn constructed ( ) or Repaired (1) aL-_ %AS.S Q k5 has been installed in accordance with the provisions of IT7r99�ii``5c a State Sanitary Cottle ) deee77 d in the application tor Disposal Works Construction Permit No TS...� T dated /f fO —7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COMET E S A GUARANTF6-Ty(¢T THE SYSTEM WIL F{�NQTON TISFACTORY. DA:` I CC"'� • �'/%D Z 1 _ er-_a. .^-.p -_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OFfj H LTH OF ceVti ftapu9a1 If�Arlili Qlnuxiirurtihn fIrrmlf gmatm..—.-_---�--2 C-dN(✓C92 Permission is hereby to Construct -) RC�sr (X) - + lndiv'dtul S aee Disposal Sysrmt ar No.— C6 Ci - /E'.�,r a� as shown an the application for Disposal Works Construction Permii��`gf7/ I1/iS/f, 3a Fns_ �a DATE_ Date MA.a M $ a 'S wn... ...t.. 1.1.r.u.14117.