232 Applications & Permits THE CON”■ONIVEALTH OF MASSACHUSETTS
BOARD Ors HEALTH
t, F OF, Q2'i�i9enp/?iic%
1lppflcation is hereby made for a Permit to Constru
4y000 l�r u-c= �•g0
cm'n j wG
gay
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building .ett.`1 (..Ha.. x:'o
Other fixtures
Design no SD �Ilons per person
a
cd
0
U
L'
(x5 or Rep
71.7 ?il
) an Individual Sewage Disposal
Size Lot Sq. feet
Expansion Attic (.10 Garbage Grinder (j/d-
of persons Showers ( - ) — Cafeteria ( )
per day. Total daily Sot
iquid capaatx%n0 ga lions a�,ength Q \Vidth2 Diameter
—No. 9S _. \`i idtlt Total
Disposal -�.0 Yi }a
Seepage Pit No Diameter Depth bet
Other Distribution box (X.) 2. Dosing Al( Q
Percolation Test Results Performed by �j.i2aXy
Length so Total leaching area
ow inlet Total leaching are+ sq
Date. 74173
•
pitons.
s.
•
6e<z
RS,
minutes per n� Death of Test Pit -_.a� Depth to ground water
$ /
Test Pit No. 1 p p � inch °��
Test Pit No. 2 minutes per ine. Depth of Test Pit Depth to ground Neater
Desceiptioa of Soil Sft4.y..ta.tly C.-qi f-74; ", —
vev...a. .s..11sienis (ikfi pots eanKV/Oit — 11,4ct rn- 4 106fn'ei 1Na.aF. gP.J.)L:__.
re of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Pie provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place tIm system in
operation untl a Certificate of Compliance has been issued by the board of heath.
Signed
A,piication Approved By
Application Disapproved for the following raisons:
llsc
an:
Permit No Issued
m:=
THE: COiM:61ONVt ALT; OT MASSACHUSETTS
BOARD OF HEALTH
OF
TIIIS IS TO CERT
/T
Seva c Disposal $ cost-rutted ( ) o i'.::_ a r d \ )
attcrsstor
i'OF,°O C ,- ALT-i
3 Lcrel:Y
) o:
a:
S
IECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
Qf�-y OF i/UQre pc)
FEZ
Appliratinn for Pizpnsttl 3 nrks Cnnuntruttinu hermit
Application is hereby made for a Permit to Construct ( ) or Repair S„‘") an Individual Sewage Disposal
System at:
y .( ? hiar:D ✓1 o f e)Cr' /
✓ ° iDi aqqa _ — ( - or Lot No.
/( ---�'---' L Ow r frn:L
Owner Address
Installer Address
Type of Building 're Lot Sq. feet
Dwelling— No. of Bedrooms Expansion Attic (/t.P Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) p,
Other fixtures 'Sr
Design Flow " 1 ons er pgson p er day. Total daily flow 2,. -I J at"
gallons.
Septic Tank—Liquid capacity L ; afot
/Length Width Diameter Depth
Disposal Trench—No. 'y Width U Total Length si L Total leaching area La Ic sq. ft. C. '`
Seepage Pit No Diameter Depth below inlet Total Inching area /
Other Distribution box (X) Yi y ` /
Percolation Test Results Performed by
Dosing tank ( a Date (i --t-
Test Pit No. 1 � minutes per inch Depth of Test Pit 'fd Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground wa«
Description of Soil
Nature of Repairs or Alterations—Answer when applicable /f.} ,,r \ - /
�
Agreement: .
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code— The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
4 Sign
Application Approved By
Application Disapproved for the following ream
Permit No.
O `/`/
c
Issued
Dan
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
n77/ OF _447/ s' " ^J
Qleriificatr of @lamptianee
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired )
by
A-5.-i:4. 5 E4r/ti4 /4'
at 232 /ifY! //i:4L Aer..C7�GF_
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application THE ISSUANCE Disposal THIS Construction IFI AT Permit NOT /� ' STf
dated 0-2.i-4y
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE 7- g -9a/ __... Inspe
THE COMMONWEALTH OF MASSACHUSETTS
. _,.. BOARD OF HEALTH
If OF -lie
No Iy
latoposaPtinritu Qrnnetrnrtinn Permit
Permission is hereby granted %->r `
to Construct ( ) or Revair (Y)- an Individua Seja Disposal System
at No �. -�-- ¢.. �x..l -c, /" ' st.e.e
" '.79/ /4)_3 f
Dated...". T
as shown on the application for Disposal Works Construction Permit,3JQ,o ' M P
P . . aga.a of Health
DATE iftil`{ - 1
4
FEE
FORM 1255' HOBBS & WARREN. INC.. PUBLISHERS
No ("
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF
HEALTH
' C r•' , OF i/- / e'
Igp l'unttnn
fur Disposal ii arks alintstri5inn rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (K) an Indixidual Sewage Disposal
System at:
or Lot No.
La tic dd-
".`x. .1...7 b.-C Address
/((t� 7t, o
(installer Address S feet
Size Lot q
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow gallons.
gallons Length Width Diameter
Width Total Length Total leaching area sq. ft.
Diameter Depth below inlet Total leaching area sq. ft.
Dosing tank ( )
sn s Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
d koC/tz . 34 o ( tS.. , .r.ork 14 0 rf ef`Er<i
Type of Building
Dwelling—No. of Bedroo ms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capacity
Disposal Trench—No.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
Depth
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
Agreement:
i
the provisions of Article XI of the State Sanitary Code—The unders gned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by�e�a of health. /
was
1 A' eLoi .1%ln -�/ / /< .f
Application Approved By -) 1` LC Date
Application Disapproved for the following reasons'
Permit No
Issued
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF )�
C k- I rtifilFtiict D tatter
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
j [< C
by r.f r. ..._./_rl�:t' ......_Ca nln.aer
i —
at
ty1 3 rd - r. , +r Tr/
has been installed in accords ce with the provisions of Article XI of The State S
application for Disposal Works Construction Permit No ).'Y^-'3
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED
SYSTEM WILL FUNCTION SATISFACTORY.
DATE
No ' '
anitary Code as described in the
dated /h,' :.. f-- - -
AS A GUARANTEE/THAT THE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF Jeri' 11" 61
tff
�ispngttl 3 narks hlnluntrurtinn Permit
Permission is hereby gran tg � eti
to Construct ( ) of Repair(I ) ap Individua',.Setage Disposal System
at No ..__...x .1.. ....,1YhS p-•L L (.4l. . Street 1
as shown on the application for Disposal Works Construction Permit`(o.. -{(3 Dated }Yet�l
•
FEE
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Board of Health
if /1U