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271 (Girl Scouts) Applications & Permits F COMNItri tt,#LI1V 0L M1\SS:\CTIUSIIIS Board of health, A/0//7///.'. 1)7J.1,..1Am, r LICAT1ON IOP DISPOSAL SYSTEM CONSTRUCTION Plinth P t to Consmmt(4 R pair QQ Upgrade( ) Abandon( ) - 4 Complete System 7Individual Components lncaeon 27/ //✓///2 4/ke/cLF .sD owners same CI/!'L 5(01'7- Pieed2 ' Map/Parcel# 4/0/277//%- ',Jr 7%/i/ e-/455 zlddrens 27/ ///2>e✓re_i ieetz. / ,t0% Lock Trlcphoneg //`J%Z f///i.4-71/7 rU/C/ /t'f, sev - zr cz { Installers Name C(_t/. �r77.r/ l Designer's Name to/Lt..//9,47 S,' >2LJ 7-, Address ro,', c : "0- TYn4; eiJ Mu Address 9'6' e--,/,-;,:),-/' P 0' ,p Telephone# 1'(3 -1-Y7- Q6o0 Telephone# //G� � ? �F�17 Type of Building Dwelling-No ofBtdrooms /3r-{?/0011-7 /r)(3 )12- 7/ Other-Type of Building /-rf 5/G/- e€' //Q/JF No.of pin sons Other Fixtures l G Des Design Flow (miinrt mired)//'J Y 3 X/,i22p�0 Calculated design now 4, Desig flow prot;ded / & nDt 577 42(:o 57,476 or- l.otSite /rd./ CT sq. ❑. Gar huge grinder '.t4 (. Showe .2_Cafeteria (,Q/1' Plan: Date 20 2C-0 3 Number of sheets / Tide Sr/>%%l 571-%F, ; D.,-3/r:(C/ /-0f2 G//2L .5ree%r72:Y6 1/4 Description of Soils) 57/ /1/ 7 /y2(./2 6 /) 27/ /J,?/6%f4 /L/-!( ,f Soil txaluator Form No. // Name of Soil Evaluator/Yr- Date of Es:dilation kJ 5/21,1-- ---//A// /2 -s--e70xJ DESCRIPTION OF REPAIRS OR AI AERATIONS 60 �7/2/O ,57917C 5/ 570- /LJ //1� (/v/ic[v /0 3/G (-n4 /' /.5"-;o /;0/7/ _12ft l 2L/7 r/041 i gpd "etc:2) The undersigipd agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree9 to norl}o plac the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed }Cp� V.--r 44/ C-17 719r1 Date 'Z%/ 66/tc04 . l/ Inspections :.) COMMONWEALTH OF IN'FYSSACIII'SLTTS Board ofHeallh �, '"./ / /tr hLA. CERTIFICATE OF COMPLIAN!'i'I: Description of Work: ']Individual Component(s) j Complete System The undersigned hereb certify that the Sewage Disposal System; Construt ted O Rep red .Upggr 1 ud O.Abandoned ( ) be.. at t. has been installed in accordance with the pi us isimu of 310 C.VMR 15 00 (T'th d the approved design l :e'as-1 ilt pl relating to application No. - dated . . App:'oved Design Fl osa ('pd) Installer Designer. r Inspector r . Date. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. So. it F COMMONWEALTH OF LI ASSCIIISFTTS Board of Health 4 H � t I . MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) Repair Upgrade( ) Abandon( ) an individual sewage disposal system at - 1- • 'as d¢sc ihed in the application for 7isposal System Construction Permit No 2 dated .. ovided: Construction shall be completed within three years of the daft of this-permit. All local conditions must be met. c i bf Date CON MON1 ,ALTII O M;1SS, a_ IIITSLTTS Board of"learn) kit HA MY7? &i APPLICATION FOP DISPOSAL SYSTDI IONS-MDT ON PhJRMIT Application ISr a Permit to Cot utrustO Repair(1t) Cpgmhde( ) Abandon( ) - Complete System 7 Individual Components Type of Building /we LL u6 Dwelling-No. of Bedrooms 3 Other-Type of Building Orb el Fisntres I.ol Si No.of p -306,26— sr] ft Garbage grinder (% Showers ( ).Cafeteria ( ) Design Flow (min.required) //O Bpd Cal- ltd deign 330 Design floy provided 3?6. 0 gpd [ham Date 7�[ /G I Number of sheets Z Revision Dale Tide DwC n GINS Description of Soil(x) LOAM? S4'JA Soil Evaluator Form No. Name of Soil Laluan FF.,SNI(HFIIJ Dare of L:naluarwtt /20/00 tile, DESCRIPTION OF REPAIRS OR AI:I IRATIONS ex(It SL/�TiC 7qN/CI `%L£AGH,NkrlYP� Wt o (�'' 7u Ke tUtuPE�,C2o�HC�aFtG[ED NEW /$00 G,oe4i.a Jepr,/ 777At �T `t SFlS LE 14).57-11Z tcp iiLl�i/Matt •rw.ussa "J u, p[yGY • The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the further Nees to not to place the system in operation t ntil a Certificate f ompliance as issued by the Bo signe al..eaoLC t2 fla4j Dates Y/It01n ,& uT Inspections Location," 71 N R/SEUs,t t ei k�tj 'it .SameC-�wpBl. 4/ J,1 Urn, Map/Parcel# MAC d 6 Adtlrexs,Z7i //AYC(ul/rt C‘ /fit) Nohn.4M7-ON Lot# y3 Telephone/ 7/3 c s ' 9s6 6 Installer's Name i lutie hg of 6xe Ug7N6 R l Deaignet's Name 42. rs7iefFyHtiii esoehoc Address/.t6 k'oce Azty& /l4DC�7 MA Aamess it IF, c7 (/24/A.:7 MA Telephone# 91 s#,9 `/ 18 1 y 'Telephone# ty; W. 7_ 7z 2-6 Type of Building /we LL u6 Dwelling-No. of Bedrooms 3 Other-Type of Building Orb el Fisntres I.ol Si No.of p -306,26— sr] ft Garbage grinder (% Showers ( ).Cafeteria ( ) Design Flow (min.required) //O Bpd Cal- ltd deign 330 Design floy provided 3?6. 0 gpd [ham Date 7�[ /G I Number of sheets Z Revision Dale Tide DwC n GINS Description of Soil(x) LOAM? S4'JA Soil Evaluator Form No. Name of Soil Laluan FF.,SNI(HFIIJ Dare of L:naluarwtt /20/00 tile, DESCRIPTION OF REPAIRS OR AI:I IRATIONS ex(It SL/�TiC 7qN/CI `%L£AGH,NkrlYP� Wt o (�'' 7u Ke tUtuPE�,C2o�HC�aFtG[ED NEW /$00 G,oe4i.a Jepr,/ 777At �T `t SFlS LE 14).57-11Z tcp iiLl�i/Matt •rw.ussa "J u, p[yGY • The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the further Nees to not to place the system in operation t ntil a Certificate f ompliance as issued by the Bo signe al..eaoLC t2 fla4j Dates Y/It01n ,& uT Inspections ]o. CONNOiN'WL\LTFI OF MASSACIIIISLTTS Board of Health, A JotrthrimpAn n� CRT FICATL t)F C0MPLIANCE Description of Work: J Individual Component(s) &Complete System The under'signed hereby ertifi-that the Sewage Disposal System: Constru t:d PL Repiu ed (). Upg:ad by: RtuCe D2 W,! fxcpvi -Hu6 FFE dband( at 271 14 A%1%/u✓/t LL kull been instilled in meindam e with the proyisi application No. dared )1,10 CNR 15011 (Title 5) and die Approved Design Flow tpptmcd de gLi pl -built pla (opt) Installer g Designer. hispeum: Doe: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. CMMONW"AIM t)iT MJASSIAI JIITSLTTS Bad ftemb, ,&)O KTUA MATO rJ MA. DISPOSAL SYSTEM t:OVIS1RL'i_I1QN PF.PNIT Permission is hereby granted to; Construct( ) Repair Q' ) at z 71 t' lyLfl J:UL R1� Disposal System Construction Permit No. fir . , dated Upgrade( ) Abandon( ) an individual sewage disposal sys tem as described in the application for Provided: Consructon shall be-completed within three veal of the date of this pre Form 1755 Rev ts, .r sewn Co.Boston.MA Date 6 �C/ B )aid of Health tL It lll local rondit}w)ti must Ix %L ' " 7L.- V CHECK OR FILL IN WHERE APPLICABLE No� " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY orNORTHAMPTQ.N Appliratinn fur 33ispnn zl Itlurks Lunutrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( - an Individual Sewage Disposal System at: _ ^/ Addressl Owner Lot Ni Ndf2 ss Address Installer Address ;Type of Building Size Lot Sq. feet Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow gallons per person per day. Total daily flow gallons. Septic Tank—Liquid capaci(v gallons Length Width Diameter Depth Disposal Trench --No. ._.— Width 3<2 Total Length Total leaching area 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. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nat yte of Repairs.or Altera ons—A�sw�when applicable �Z iµ1 �� ee firliat/ or / -e 7.441,: ,fie ".„2,--414- Agreement: i '.-. The undersigned agrees to install the aforedescrihed 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 b-Toe issued by the board of health. Application Approved By Application Disapproved for the following reasons' vier ( Atep in accordance with place the system in Permit No 2 Y� Date Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY of NORTHAMPTON &ertifirtttr of «Lnmplittnrr THIS IS TO CE%ARTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (A by .-ti.M-..QrdJ:].5..tim...._......_u ) I missert.. _tra irr.rd -ti at 2-71--///JY/ /LY.::, /;r-,•,q© has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application Disposal IS Permit d .6fe// THE SSUANCEOF 7H CERTIFICATE SHALL NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 /f -�-- G•; ...! . -! "0:'0'71 DATE ��/���.� Inspector. .�-f No -Jr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITYor NORTHAM.PIO.N Uthptunti iligyks tnnstrurtinn irrmit Permission is hereby anted to Construct ( ) qr Repair an Individual Sewage Dispospr System at No � ! 1 as shown on the application for Disposal Works Construction Pe . S 1✓ _/Board OI Health / DATE L./ //' � FORM 1255 A. M. SULKIN, INC.. BOSTON IN WHERE APPLICABLE CHECK OR FII. No..� ' Q - THE COMMONWEALTH OF MASSACHUSETTS Fx /e.ez/ BOARD--1 HEALTH CA-Appliratinn fur Bispusai Works Qluuntruutinn thirtnit Application is hereby made for a Permit to Construct ( ) or Repair (la-an Indic idual Sewage Disposal System at: (f 0Ai Installer addrev 0. l4/42:�i���ess (2- dre.. Type of Building Size Lot Sq. feet Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow gallons per person per day. Total daily flow gallons. Septic Tank—Liquid capacity gallons Length Width Diameter De t Disposal Trench--No a-........ Width Total Length..sO- Total leaching area sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area 311i" sq. ft. ) Dosing tank ( ) Performed by �le�—� : s� Date._et '' minutes per inch Depth of Test Pit Depth to ground water s minutes per inch Depth of Test Pit Depth to ground water 7 G Other Distribution box Percolation Test Results Test Pit No. I Test Pit No. 2 Description of Nature of Repairs or Alterations—Answer when applicable— -t - 4; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System - The provisions of 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 healltth..__+� •.Sig/ne'd' �l R�L =° '_F..a.r1 • ./ Application Approved Byf� Application Disapproved for the following reasons- in accordance with place the system in 7/7- i— Date Permit No Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,I OF H LTH OF Vt. rrtifirtttr of tLCnmplitt 'r THIS IS TO CER Y�That he In`! ,..1 Sewage 'sposal System constructed ( ) or Repaired (4--y - by \....) tivlUA� i ztaller - at has been installed in accordance with the provisions of TIT`yy'?u j f The State Sanitary Co e as d crib the 1'T— I�� dated 1.qs I., '• application for Disposal Works Construction Permit No j '- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST-ED AS ;GUARAN EE THAT THE SYSTEM WILL FUNC 1 N��/g{A(j IFFACTORY. DATE Yf31 `� d-- Inspector No I I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Jf{t.-✓s..L.< A-0r 1iis}Tnsttl 3iarktt fnun#rucina ermit Permission is hereby granted r / to Construct ( ) or Repair ( y an Indi tdital Sewage_Ut'possal System , i`, at No F� �A!s I_.tt 4 stria /< Y 1 7 5 a as shown on the application for Disposal Works Construction Permit No Dated.. 9. % yr JL t .ra: .. ,�.�.■ ysara of Health {i/ FSE DATE f ''/4, FORM 1255 HOBBS 8 WARREN. INC.. PUBLISHERS ERE APPLICABLE CHECK OR FILL IN No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF �d l"t/ P'1'?, n'• Applirntinn fur fiapngnl 3 nrkn @tnngtrnrtinn Prrntit Application is hereby'made for a Permit to Construct ( ) or Repair (Y) an India idual Sewage Disposal System at: --pet Location-Ad Owner or Lot No. /address Installer a Address Type of Building Size Lot Sq. feet Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of person, Showers ( ) — Cafeteria ( ) Other fixtures Design Flow gallons per person per day. Total daily flow gallon. Septic Tank--Liquid capacity gallons Length Width I)iamete- Depth Disposal Trench—No Width Total Length Total leaching area sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. fl. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or Alterntinns—Mswer when applicable [ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been by tfterd of health. Signed AYL.2_hT-o.l- Application Approved By a-efae/7/(4: Date Application Disapproved for the following reasons. Permit No Date i 7 I96LLCd....__/!- to % Da4 by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF hirrtifiratr of Tnmplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired InmUner at I as been installed in accordance with the provisions of .Article X I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector No r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF its 6 p �i5}Tnsal iinrk5 Crnn5trurtinn Prrmit Permission is hereby granted y / a -r.ta �A,j to Construct ( ) or Repair ( t i an Individual Sewage Disposal Systfai at No I / to /— r'enh as shown on the application for Disposal Works Construction Permit No R Dated DATE FORM 1255 HOBBS & WARREN. INC_ PUBLISHERS :._.1? 11 '.7 Hoard of Health CHECK OR FILL IN WHERE APPLICABLE 6 FEE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirntinn for Disposal rI grits Cnnnstrurtinn ¥rrmit Application is hereby made for a Permit to Construct /or Repair ( ) an Individual Sewage Disposal System at: , t atio �t t el r or Lot No. Address Installer Address Type of Building 1./- Size Lot Sq. feet Dwelling-No. of Bedrooms LJL -L Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building f No. of persons Showers ( ) — Cafeteria ( ) Other fixtures - Design Flow / '-' gallons per person per day. Total daily flow °1 0 0 gallons. Septic Tank—Liquid capacity/J0 °gallons Length Width Diameter Depth Disposal Trench—No. Width Total Length Total leaching area S6 B sq. ft. Seepage Pit No ✓Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Resulxs - Performed by Date Test Pit No. 1 • minutes per inch Depth of Test Pit Depth to ground water Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water Description of So; 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 issued by4 e b o f,irealt)t. Application Approved By wj"rt aua4-.1 -" is,cv ft f Application Disapproved for the following reasons Permit No 66 Date Date mm IssuedDa/a _L.7k. by at has been installed in accordance with the provisions of Artick XI of The State Sanitary de s described in the application for Disposal Works Construction Permit No 0e dated k THE COMMONWEALTH OF MASSACHUSETTS if BOARD J OF,,HEALTH OF 1/C1-'L' s n, -4a% rrtifirtttr of (nit>ptittnrr THIS IS TO,CEPTIFY,pat {lie [ndividual Sewage Disposal System constructed (r' ) or Repaired ( ) ) 4 kf t; :?.4"A allele. C / its-cd t. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM MILL FUNCTION SATISFACTORY. --■ ,( ,� DATT L,- 'C "i i l00% Inspector 'is. C °'�{Y�'"n, Cl7 THE COMMONWEALTH OF MASSACHUSETTS BOARDQF HEALTH /I S f. OF.. ,e1.-mod.V7-71? Perntissioyis hereby granted to Constructjnfi& (individual t$ew ge is o 1 System at No into 4nutinnrrmit FEE street as shown on the application for Disposal Works Construction.Permit No. DATE FORM 1258 HOBBS & WARREN. INC.. PUBLISHERS ted.>s-f-t. ' 9b Y meal u( I Malt ERE APPLICABLE No /3-7 THE COMMONWEALTH OF MASSACHUSETTS FEE '�• BOARD OF H ALTH OF YL) l iyliratinn0ar Elispunat i i(orb innnstrurtinn lrrmit Application is hereby made for a Permit to Construct System at: 6 Type of Buildin Dwelling ANo. of Bedrooms Expansion Attic Other—Type of Building No. of persons Other fixtures Ic or Repair (A an Individual Sewage Disposal or Lot No. Address Address Size Lot Sq. feet Garbage Grinder ( ) Showers ( ) — Cafeteria ( ) Design Flow gallons Septic Tank-Liquid capacity*—? gallons Disposal Trench—No Width Seepage Pit No_________ ____ ______ Diameter Other Distribution box Percolation Test Results Test Pit No. 1 Test Pit No. 2 per person per day. Total daily flow gallons. Length Width Diameter Depth Total Length Total leaching area Cr CO sq. ft. 014 X 3< Depth below inlet Total leaching area sq. ft. Dosing tank ( ) 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 Description of Soil Nature of Repairs or Alterations—Answer whenptpplicable ' taUh/ aa0.) #71„,"," a- et. 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 payd�of heal*. \. 013 operation until a Certificate of Compliance has beep issued by the Signed Application Approved By 4...di'( 1!...„le Application Disapproved for the folio Date Date ng reasons• Permit No Issued 4. 4 .2Date Date ..? 74.._- ... by at 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 `..��C dated 0 cal THE ISSUANCE OF THIS CERTIFICATE SHALL NOT �E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLI FUNCTION SATISFACTORY. .-.s .:. �- r ( 1--�G-< Inspector_.0 4e is Ge.-L )f DATF THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALT OF 21 rriifirair of aumpliaurr THIS IS TO CERTIfV', ThA ,thg Indic al ewage DisppsalSyst con ,i,e rM ) r.�.tl -o-w. t7 /, Installer a91 ucted ( ) or Repaired (A No t3/ Permission to Construct at No as shown on the THE COMMONWEALTH OF MASSACHUSETTS BOARD OF I�FyAIT,-li of trth „^'7i�°7T° lit ignmal jn%�tu is hereby grantef}. ` nsir 'M rrmti/ FEE 9T R pry i( J an ndµydw l gyv pe Disposal System e. Steel — q application for Disposal Works Construction Permit No 0 3 J Dated °Z'3 DATE FORM 1255 HOSES & WARREN NC.. PUBLISHERS Board of Health