Lot 42 Title 5 Application/Permits 1973, 1991 CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS.
OAF D OF, J-IEA H
O
Application for Disposal inorks (onstntrtian lrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
Vern
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capacity
Disposal Trench—No. 9—
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( %�
Percolation Test Results Performed by /•%x Date
xG+�"•_
Test Pit No. I 2- 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
or Lot No
Address
Address
3 Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder )
No. of persons Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow Z. S— gallons.
gallons Length Width Diameter Depth
Width.....3Cu" Total Length .SU Total leaching area. sq. ft.
Total teaching area sq. ft.
Description of Soil
Nature f 5zairs orAllt�erations— er w appli
it, ....5_0 l (4c
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 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.
"e„.—.0GL.
Application Approved By
Application Disapproved for the following real
Permit No
Issued_
path
THE COMMONWEALTH OF M' _..- -----.
BOARD OF HEALTH
OF
rrtifiratr of Clomplianer
THIS IS C .RTIfYC That Individual Sewage Disposal System constructed ( ) or Repaired
by
'r- t.lw
at
has been installed in accordance he provisions of TITLE 5 of The State Sanitary Code d ribed in the
application for Disposal Works Construction Permit No 5.3-9/ dated $ 3. I
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTUD A GUARANTEIF.Tj1AT THE
SYSTEM WILL F,4t)NCTTlON ,S FAs,T?R�.
DATE .jY+� / %i7/ — Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ,HEALTH
OF 1 ti"r✓`i{ -
Bisons
Permission is hereby granted
to Construct ( ) or Repair ( x) an
at No .�.... Q .11'til�v`�t,/
i3
FEE
reidtlal S. a Disposal System
Street
as shown on the application for D' posal Works Construction Permit N
DATE
FORM 1255 A. M. SULKIN. INC.. BOSTON
0 of Health
CHECK OR FILL IN WHERE APPLICABLE
No 59
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OOF'� HEALTH
Application for /t panat Mirka i,QI trurtiuu f rrutit
FEY JS / 6
Application is hereby made for a Permit to Construct ( ') or Repair ( ) an tndie idual Sewage Disposal
System at:
;344.`"`A s.F,4.
eeP
aya_
or Lot No.
Address
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 gallon..
Septic Tank— Liquid capacitan gallons Length Width Diameter Det0h
Disposal Trench—No. Width Total Length Total leaching area Qa.brisq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching ere sq. b.
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 Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrihed 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 issi d by the board of health.
Si ned g
Application Approved By '1�Q /�-r— — °�Zr-/Q
nale
Application Disapproved for the following reasons•
Permit No .5-9 7
� p Dam
Issued UZC-G. °�e..-/.?.7 7
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Trrtifiratr of fanmplittnrr
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 = Yf
THE COMMONWEALTH OF MASSACHUSETTS
/ -J BOARD OF HEALTH
CAB tq OF 7,i.0 2r✓+ru
rUr
Jinpogid.-1,1,10 on trurtinu ry
hrmt
Permission ereby granted f41.SAL.it aa�i
to Constru ,) of Repair ( 3.) an Individual Sev .ge Disposal System
at No :f_Af iZ f l i rt;.. .,A}' .try
If%.i
as shown on the application for Disposal WororConstruction PefMyt No i — Dd L. s� `v
+ F
FEE-fQ 0I
DATE
FORM 1255 HOBBS & WARREN. INC_ PUBLISHERS
tal 67 I
Board of.Health
ERE APPLICABLE
ECK OR FILL IN
No 6/,C
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OFQ-H' KG1.'/X/�h(
I#rpliratiun fn flibpn~3tt1 Norio Tmwtrurtiuu Permit
Application is hereby made for a Permit to Construct (" ) or Repair ( ) an Inch:dual Sewage Disposal
System at:
ler
or Lot No.
Address
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 capacit4aMgall ons Length Width Diameter D/epth
Width Trench—No. idth Total Length Total leaching area__JO.CDsq. fl.
Seepage Pit No Diameter Depth below inlet Total leaching area xi. ft
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 watc-
Description of Soi
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code si,The undersigned fu flier agrees not to place the system in
operation until a Certificate of Compliance has been i su thebpard Q(1 th. p
Signed_ 1 "t/'r nil �/� ume
Application Approved By 'ke 9A. j + �t} - A/V.-'l-p /I73
Dale '
Application Disapproved for the following reasons'
Permit No..e./.,�
Date
Issued.. ::W. 2 9 /97 z
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qlrrtifirufr of Tnmplianre
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 615
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD�AfQO'�F -H.EALTH OF,Ip ,—�
Y
Bisons'' {cif arks Tonhtrurtinn 4rrmit
Permission s eby granted..- e Jr"( Zief'
to Constr (/, Jr Repair ( ) an Individual Sewage Disposal System
at No.... -�.{ TTT5"- "` (J.�__ ra„ytat�..t'S.(.E.b.A
ii e).., Seva / •
as shown on the application for Disposal Worts Construction P�IIItit No_.. /.5 Dated._-Board of He°
s �r
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
- '1