125 Septic Applications & Permits CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
-."[".��y OF. iris "t'�d%1
Appliratinn fur Rspnsal 10 arks Qlnnntrurtinn Trrmit
Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individual Sewage Disposal
System at: /� a/` !!��
J 6tUw22vt 'W.
t u.t Le tt
Owner
or Lot No.
Address
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Fxpansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow n gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity 7"n....
ssa Length Width Diameter Depth
Disposal Trench—No. ! Width Total Length....4 / Total leaching area '/./i d sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. I minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 9 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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu h)y 9 board of heap)).
Signed �." / `✓L. — 1.
l
Application Approved By
Pit
Date
Application Disapproved for the following reasons•
Permit No 10
Date
Issued . 3� /%E
Date
THE COMMONWEALTH OF MASSACH USETTS
BOARD OF HEALTH
OF � 7
attitude of Qlun[plinnre
THIS IS;)'Q CERTIFY, That the Individual Sewage Disposal System constructed (y ) or Repaired ( )
by .C..' Z1?..�-1 -
Installer
at 104-- i,ny(I?AEi
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 1 0 l dated (.t.f..t% _L:%.a..°/
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1
DATE : Lt P, i ` y Inspector '‘...../. •`-.( 3-L ./lk.:25,� _](1,A l
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
D OFF H„,E`A/L�
�t ..}}
�thpunul, 4rk, ,(duns rurtiun Permit
Permission creby granted .vCOI 11
to
at Co Construct,}ori Repair j ) r » idual Sewage Disposal System
FEE
Street ) Q 6
as shown on the application for Disposal Works Construction Pera}tit No
, 7
DATE
FORM 1255 HOBBS & WARREN. INC., BUBL/SHERS
Dated (i+•^'i' `: /
Board off
V }
No Faa
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c/TY OF 4(0/7102>.WY
)ppliratinu fur Disposal IMPnrks Cnnnstrurtinn rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual
System at:
I Z5 CRc<_i,r=RTY, R„a,W
Sewage Disposal
nio< A ' AkVittfWIlf' l z5 c/E( Lot No or
JUS EFR F !/ys4NCS (t; 2 t /96 °/Y`. ? C?/VF .AWNs O
a.y Meq
Installer Address
Type of Building i Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garhage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
gallons.
q. ft.
Total leaching area sq. ft.
Date
Depth to ground water
Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable 45F-&A' -" ,' r Qt.i -qy
FACl41, WITH /4e0 GA/toN c4JPA(tr7 oAy ,p...,
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 not to
operation until a Certificate of Compliance has been issued by the board of health.
%Signed...
i
Application Approved B ii17/1" C
Application Disapproved for the following reasons•
in accordance with
place the system in
7/z ; z
Dam
41? SiZ
Date
Permit No 2 7— a
Issued 9121 d`L-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
nnY OF..NoRry9mvrai'
OIrrtifiratr of f nmptianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (/)
by ZOSEPH F. L✓9,NatKK.:..Ring.1JFLL=---EXL:i(//u:.liYG
Installer
at I Z6 CIf(SSPAT/ k&)
has been installed in accordance with the provisions of TITLE 5 of fThe State Sanitary Code as described in the
2 p!N
application for Disposal Works Construction Permit No
7 -2.. dated 7_P.Vr-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
/f z
DATE s/Ti Inspector:: ___'a --------
No27—FL
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
UIIIpDsat I:arks Tsnstrnrfian tirrntit
Permission is hereby granted .70-S47FN E' wMNCZy[�
to Constr�Itct ( ) or Repair ( i.an Individual Sewage Disposal System
at No /"AU< fl- esAt Yt .* .(_2.5 CRCS5p197 '4 /f=%ip
so-ymoz7-s z
as shown on the application for Disposal Works Construction
DATE %lZ:/f'L
FORM 1255
FEE"
Date 9./25/i4
/$4
r1
7„,bgatd o[Health