Miscellaneous Lot Title 5 Permits/Applications 1969-1978 CHECK OR FILL IN WHERE APPLICABLE
No.2 .0' b ns/s o a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Inl 0
Application p n
nal Iliark ' QInu!trurtinn Permit
Application is hereby made for a Permit to Construct (v) or Repair ( ) an Lida idtuil Sewage Jisposai
System at_ e
Gf 12trY44-
a 1 ke l
trtnajer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building - No. of peons Showers ( ) - Cafeteria ( )
Other hmtures
Design Flow gallons per person per day total daily !'how gallon-
Septic Tank—Liquid cataci M - :dlons „Length Width I Sameter D
Disposal Trench No. 62.6 Width 76 Total Length Total lead ear__�i a0' sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching;ae- Sq. c.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by - Date
Test Pit No. 1 minutes per inch Depth of Tcst Pit Depth to ground wate• _.
Test Pit No 2 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 NI of the State Sanitary Code—TI c undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued L}y aTd of health.
C�Lc.
Signed .t
J
Application Approved By
Application Disapproved jor the following reasons-
nee
Permit No._p..o....0
Issued_ OC2 ; ar iq t
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Otrrtifiratr of kiamplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
mst.alter
at
hats 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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Uiiipaual iflnrku (nnntrurtinn Permit
FEE
� 'G
Permission is,hereby granted.._ __ ____ -, t_. . ...
to Construct (:6 or Repair ( ) an Individual Sewage Disposal System
at No
St: e
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
FORM 1255 HOBBS & WARREN. IN PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
too
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD/O1 OF HEALTH
Of-' OF A.)0.2.Ttt M_PTO
.f_%
Appthatinh fur Dismal ?flnrks jlnnstrurtintt '11rrmit
Application is hereby made for a Permit to Construct
System at:
Pjlzp,,,&_/NG C i p S
on-
Tress
Installer
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
Other Distribution box ( ) Dos ( )
Percolation Test Results Performed b - - e
Test Pit No. I minutes per inch Depth of Tes
Test Pit No. 2.2.0 minutes per inch Depth of Tes
Aa.tx-Qt ea4fnlifet
or Repair ( ) an Iudi%idual Sewage Disposal
f t..:.t
tve-cr4je
o.
fN..,..!-1 S.S
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) arbage 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.
Depth below,inlet Total leaching area sq. ft.
Description of Soil
Abbe- /2e4 -�—�y ✓v �_a..+
Nature of Repairs or Allteratiorli—Answer when a livable
_._._ .. .. .r__. Date a-.4- Cal
rt
Pit 6 r epth to ground water ..
...
Pit S.J6 11 epth to ground water
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the pi ovisions 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
Date
Date
Date
Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
No FEE
THE COMMONWEALTH OF MASSACH USETTS
BOARD OF HEALTH
,e OF .1
Appiirafinn fur ]inpusal ado 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location Address ! _ or Lot No.
L:
Owner
Ad ss
/
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 capacity42L.T..gallons Length Width Diameter Dept�.�........._..
Disposal Trench—No. Width Total Length Total leaching area. - sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box (V) Dosing tank ( )
Percolation Test Results _ Performed by Date
Test Pit No. I ,'l' 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 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 bee¢use)ed by the bold of ir i .'"
Date t
Application Approved By
Date
Application Disapproved for the following reasons
Permit No -- - / Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Tent' of fdnm.{flitturr Y(
or IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( tC or Repaired ( )
m,taB4r
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 2, y=f dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ... (.4.t...% Inspector.....,a Of
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Moping Gl'orks Otuustrurtion tirrntit
Permission is reby granted -- sayer
to Construct ( r Repair ( ) an Individual Sewage Disposal System
at No . I .I
Street
as shown on the application for Disposal Works Construction Permit No - 'i- Dated
FEE
DATE
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
Board of Health
CHECK OR FILL IN WHERE APPLICABLE
No FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOAR Q OF HEALTH
OF
.4ppliratinn for 3)inpnsttl �i nrb I1 i trurfinn jrrmit
ton is hereby made for Permit to Construct ( or Repair ( ) an Individual Sew
Application age D
Systeti at:
L stMn•Address
,them 1
them
Installer
Type of Building
Lv OrQ, 110-4A
po
Address
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 11 gallons per person per day. Total daily How gallons.
Septic Tank—Liquid capacity) fi gallons Length Width Diameter Depth
Disposal Trench—No Width Total Length Total leaching area sq. ft.
Seepage Pit No Diameter s2..th below i t Total leaching/arr/ea sq. ft.
Date....li 3... L.
'O.f
Other Distribution box ( )
Percolation Test Results _
Test Pit No. 1 Y�
Test Pit No. 2
Dos
Performed by
minutes per inch
minutes per inch
/ /4
Depth of Test Pit..lrr a'th to ground water.. -2
Depth of Test Pit I epth to ground water
Description of Soil. ¢r ,ent.
f
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
Date
Dam
Date
Issued
Date
VHERE APPLICABLE
CHECK OR FILL
•
No 7i /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C: OF
FEE J O 6
Appliraiinn-fur flispnnal iflnrks Qinntitrn9inn 4erniit
Application is hereby made for a Permit to Construct ( ) or Repair ) o: Indic idual Sewage H posal
System at: t
Type of Building Size Lot Sq. feet
Dwelling— No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building _ No. of pe non. Showers ( ) — Cafeteria ( )
Oti ter fix t tires
Design Flow gallons per person per day, Toad daily '.'v -- . . anon-
Septic. Tank—Liquid capacity gallons Length Width )i:ureter - Dept
Disposal Trench No AV idth Total Length Total leaching area._ - H. n
Seepage Pit No Diameter Depth below inlet Total lead titig area
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 state
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable aka CC– , 1 eCg6t
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 issued by the the board of health.
Sign : ..C/Ll&r-j by 4L1 —__1 Lp',/�.�
Application Approved By --�'+- �- --"' b- /977
Date
Application n Disapproved for the following reasons'
fig?
Permit No
7177 Issued._ if
!
�1..
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
0.1rrtifiratr of Tamplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 1 or Repaired
Installer
at
leas been installed in accordance with the provisions of Article RI 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.
DATP Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Uioposttl Marko QtonMtrurtion drrmit
Permission is hereby granted 7,,
to Construct ( ) or Repair (" an Individual/Sewage Disposal System
_ ! ,
at No
�"'e Stan
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
FORM 1255 HO SS a WARREN, INC_ PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No.._.Q✓I
THE COMMONWEALTH OF MASSACHUSETTS
Fas
, BOARD OF HEALTH
/7
/ t- OF /./t} /ICI,g74T.GCtj
Application f r fliapasal Marks Lanmtrurtian hermit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System at:
Innt.
Locat
.4
14144__
aiaa.
er Lot No.
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
Septic Tank—Liquid capac
Disposal Trench--No.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
gallons per person per day. Total daily flow gallons.
QO..gallons Length Width Diameter— Depth
Width ,c94 z Total Length
y((d Total leaching area..ge sq. ft.
sq. ft.
Diameter Depth below inlet Total leaching area
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=IT': 5 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.
Application Approved By
Application Disapproved for the following reasons'
1%_9.7.x"
die
Permit No S13/
Issued...4.2.'44..l p-..197(1
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
irrtifirtttr of Tort it anrr
THIS I$ TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Re
by Installer,
ed ( )
at •.. : ....-.: .�:...-ew - ,-, . . ..
has been installed in a¢wrdavre with the provisions of TITLE- $of The State Sanitary described Code as describe mt the
application for Disposal Works Construction Permit No Ldi dated -?- `- L I i �.
� 1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
/
DATF % - tom t .. .f I Inspector _. + - .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF i
No -i .. FEEL ' t
dinpnattl iflnrkn Oktnntrurtinn 1rrmit
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
street
as shown on the application for Disposal Works Construction Permit No.. Dated
DATE
FORM 1255 HOBBS 8 WARREN. INC.. PUBLISHERS
Board of Health