285 Septic Application Permit & Plans CHECK OR FILL IN WHERE APPLICABLE
No..E.c.L.�.._
THE COMMONWEALTH OF MASSACHUSETTS
F
„ . BOARD OF HEALTH
L� l7y OF i(joelt"
Appiiratiaa far Dismal illurkz Qlatutrurtinn thrtnit
Application is hereby made for a Permit to Construct ( ) or Repair (X5 an Individual Sewage Disposal
F! CL DS'(
711-nitt°- drCztle/van( 4-9S. l�/0-inac0
System at: n 9
Owner
Address
IostaL'er Address C
Size Lotf•1
vdCD ^Sq. feet
Expansion Attic ( ) Garbage Grinder (k t,
No of persons Showers ( ) — Cafeteria ( )
Type of Building
Dwelling— No. of Bedrooms
Other—Type of Building
Other545-es
Design Flow allons per person per day. Total daily flow
i )) . ons Length____.LQ. Width Diameter
Septic Tank—Ligmdbapactty_[.. i�
__
Disposal Trench--No Width ' Total Length �t
Seepage Pit No l Diameter /Q%`LZ.Depth below it _efltr
Other Distribution box ( ) Dosing tank ( )0a
Percolation Test Results//, Performed by
Test Pit No. 1 aS minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
Description of Soil
Nat of Repairs or Alter TT_n_s—Amster when applicable
(...0L1.fA-S[. i 77 C. 1Pf4 C ('iAs.Q
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees ot to
operation until a Certificate of Compliance has be: issue, by th- .oard e malth.
,i' , /_
Sign i
Application Approved By !jar fa-
peons
D th Are Sr
Total leaching area is d sq ft
. Total leaching area__/..j._O.sq. ft. � !
Date 1-/r-Z`j,l LTT'rt /
Depth to ground water-.^.�({�E1rf
Depth to ground wa
in accordance witl
place the system in
.. /99/
2411/
Application Disapproved for the following reasons'
Permit No
Dam
Issued_
Date
THE COMMONWEALTH OF MASSACHUSETTS
y BOARD OF HEAL H
OF
� rrtifira of tanm}Tlittnrr
THIS ISM CERTIFY, hat the Iny'vidval Sewage D�yogal System constructed ( ) or Repaired (x)
by % .. ..-�...
--I8-CYr
has been installed in accordance witi'tire provisions of TITLE 5 of The State Sanitary Code as
described in the
application for Disposal Works Construction Permit No../5.--1,1 dated —1-27
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL,IFUNCT/ SATISFACTORY.FACTORY. 9 Cr‘
t".-
II ZZ CC�11""nn'' l Inspector �J -
THE COMMONWEALTH OF MASSACHUSETTS f . . A.
BOARD QF HEALTH
of F: I f. FEE
Oinpn$al� nrknfQniystrnrtinn lrrmit
Permission is hereby granted // it'., L '
to Construct ( or Repair O an Individual Sewage Disposal System
at No _ G y
Street
as shown on the application for Disposal Works Construction Permit No / Dated
l{ Board of Health
DATE ", 9
/
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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Plan app
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PLAN a
of Nealtagc wAcc a AL
conditions: Re pr{lot
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N
ol /( 2% IAin,) Finish 'Grbde
p 12 Min. 12 Min. _ n
4 Oia. (Alternate) -_�}.� _, f C ---x--
Top of Stru2ture (Alternate) r a
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Natural Soil —p v_ m
C
z
a o
fal this Point Effective r a
of this Point LEACHING PIT, Depth m 0
A .,t 2
3/4 I I/2 'GALLERY or CHAMBER Fn c <
n_ A
rri
12• Min. m
Y;shed Stone 48•IAax.c
Z Y
m z
ExCavotion - m
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Sidewall '�. _ r
r 0
r C
Min.=Twice Effective c a
y C
Elf c or Diameter or Diameter a y
or Depth y K
ta o
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a m
i ' GALLERIES, CHAMBERS a
A LEACHIiVG P1YS, z
n
No Scale
Illustration A