Lot 11 Title 5 Application/Permits 1967, 1972 CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OA.t./ OF P111 .. '.FYK. �n
Application for %plum! el ado Cnanftrnrtinn hermit
PEES .G!.1!
Application is hereby made for a Permit to Construct
System at:
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow gallons
Septic Tank—Liquid capacity gallons
Disposal Trench No. Width
Seepage Pit No Diameter Depth below inle
Other Distribution box ( ) Dosing tank ( )
Percolation 'Pest 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
rye
ion-.tasae:
L1thi � .
ler
( ) or Repair
ndieidual Sewage Disposal
or Lot No.
Address
Address
Size La t Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
per person per day. Total daily flow gallons.
Length Width Diameter Depth
Total Length Total leaching area sq.ft.
Total leaching are sq. ft.
Description of Soil
Nature of Repairs or Alterations—Answer when applicable_W a. eeiliex -F .kCee-r-/J
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article AI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by he b of health.
x
Application Approved By y/J ..BCC(.A Seritect.1',�`J
Application Disapproved for the following reasons
o- Bate
Permit No
•
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(IIrrtifiratr of Qdnntplittttrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
installer
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 dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
No....J 4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF '..I L(itxl. ;.t
Disposal jr/r;arks TPart�sy `t�rue_tinn rrmit
Permission is hereby granted.^'.CC i,jg. :r w6
to Construct ( _�i) or Repair (V) an Individual Sewage Disposal Sys
at No -i41.4-2-.... .(.Q.....a 1Y-st.a44-wr... so- .g
as shown on the application for Disposal Works Construction Permit No.-5:i_9 Dated Yy..c`,.`y._.1..�!...,(.Q.71
«R.Y ::`^t.:C.�. / -:r 4r,Ek. ........ ._
FEE .4t.l1
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No....:ti.y..a.2...-'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...�C-•t,. OF _ • - r _
Appliratinz /tnr Binvimal rG arks (IInnstrnrtinn Permit
FEE
Application is hereby made for a Permit to Construct ( 7 or Repair ( an Individual Sewage Disposal
System at:
f-iz: c-a- -f
Owner
.111:%/x-' / >._,. t...�.r :•;—
Installer
jtmn
Type of Building
Dwelling—No. of Bedrooms_,
Other—Type of Building
Other fixtures ... __
Design Flow gallons
Septic Tank—Liquid capacity gallons
Disposal Trench—No. Width
Seepage Pit No Diameter
J'
Address
ddreas
he Lot S(feet
... Expansion Attic ( .) Garbage Grinder (C1)
- -- No. of persons Showers ( ) — Cafeteria ( )
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 sq. ft.
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 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 by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons
Permit No i sL.. Issued._.Alit
Date
-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
tQrrtifirate of flmapliaurr
THIS IS.TD CERT FY, That the Individual Sey+a e Disposal System constructed ( or Repaired ( )
by j `t L'J
xas l..
at �Per 7,1/4
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 dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Lss 4 4_1..1L' ( Inspector
No....a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF <:.1.-fra :.cn'6ft
Disposal ra nrks @lnnstprtinn 1rrmit
Permission )sjbCreby granted -^"T-'`fi -Ala-
to Construct (‘,10) or Repair ( .) an Individual Sewage Disposal System
at No ^1 ::an:^.%. Street .,tt
as shown on the application for Disposal Works Construction P.
etmit No X i..S_ _/.. Dated
aGra of kith
FEE
DATE
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS