Title 5 Applications/Permits, Unlabeled Locations 1960-1980s No. 4'47
THE COMMONWEALTH OF MASSACHUSETTS
NORTHAMPTON MASSACHUSETTS
FEE ■
cApplictttion for !ispostti $gstem @lonstructiou Permit
Application is hereby made for a Permit to Construct(X)or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No.
LOT 4 North Farms Road
Florence, MA
Owners Name,Address and Tel.No.
Kevin Heafey 584-1871
t u MA
011
Installer's Name,Address,and TeI.No.
Designer's Name,Address and Tel.No.
Steven Frederick, P.E.
248 River Rd. Sunderland, MA
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building
Other Fixtures
4
665-4873
Garbage Grinder(X)
No per Persons Showers( ) Cafeteria( )
01375
Design Flow 880 gallons per day. Calculated daily flow 440 gallons
Plan Date 6-3-97 Number of sheets 2
Title Subsurface Disposal System - Lot 4
Description of Soil
Revision Date
0-12" Topsoil, 12"-24" Subsoil, 24"-43" Silty Subsoil,
43"-120" Sand & Gravel to Boulders
Est. Seasonal Groundwater at 47"
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by this Board of Health.
Signed
Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No
Date Issued
60
THE COMMON ALTH OF MASSACHUSETTS
DRW'd --17 - MASSACHUSETTS
@letttificate of Compliance
TH S IS_'O CERT/ that t On-site Sewage Disposal System installed or repaired/replaced(- ) on
b r CoCt4 e ^r CT for (ri-,. Nn1,
at `/ ,yr �t �'�✓f4� h&s been constructed in
nT477 dated
Use of this system is conditioned on compliance with the provisions set forth below:
accordance witthtgeeproyisions of Title 5 and the for Disposal System Construction Permit No•
The issuance of this certificate shall not be construed as a guarantee that the system wilPfunction as designed. This
Certificate expir on //())
DATE rA �` 7 r 9 Inspector - `C-1 hJ / .(rs
U a)
tc .)-+ Erw,.yu •
� 'r a, O !topsail SgSte
tom 0 a
a"ir1r-10 PU [ IC
E - m m wermission is hereby granted to
Ot¢ctnstruct((%)'or repair( )an On-site Sewage System located at
c, arc
8 C ••u'+ a r:
C •.i 'O Sl
THE COMMONWEALTH OF MASSACHUSETTS
efr i471
G/ /92
SSACHUSETfS FEE
"v e
Construction Permit
Pa 1-‘P
AWACS o/-
i , alaad aas described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
t:.L LWdkrr,Io comply with Title 5 and the following local provisions or special conditions.
E) > FiA I construction ust be ompleted within three years of the date below.
wtiv C
o 2 y 14TE C�.'/ / /9\// Approved by
• FORM11255 Hey.b95 A.M.VLKIN CO.-BOSTON.MA
>105-E-
'_
No.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O�F� HEALTH
eicy, OF /L!d+e7.8e4 P->onJ
Application for Qispusal ri,ado (ltnnstrurtion Hermit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
- -
ZIACZeli EAV=.....: uso_..._........... t9
�'/ Location.Addrey Lot No.,
—I{,r[ii...L£l.tY_L.._ 21.�7i'SQ:51 R?.QO_.d(•
CL"ni Sr .h.27/1H.A1F7re.J
Address
Owner
Installer Address
Type of Building Size Lot ."l„ /iO.P Sq. feet
.a Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
aai Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
G Other fixtures
W Design Flow gallons per person per day. Total daily flow gallons.
C4 Septic Tank—Liquid capacity gallons Length Width Diameter Depth
xDisposal Trench—No. Width Total Length Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
4 Other Distribution box ( ) Dosing tank ( ) ,�...,,//
Percolation Test Results Performed by.2L.fhi4/.QT•-#.40/rt4Y trNGR ' Date 471-S a-
;lj lest Pit No. 1 3 minutes per inch Depth of Test Pit 3'3•' Depth to ground water a He
*et Test Pit No. 2....O minutes per inch Depth of Test Pit./a -O ` Depth to ground water._cr- a_`......
ODescri lion of Soil.?c CiPr??,P.A.G.7g7.1 GL_A..S.l.A4r -27W 4.- 11"O,f6447/‘ 7RPSa/t,,Q,�' SA.x/d!
u C 44 / 4 pluc. Tc-hy7 TAKEN A./ oCL4y49....Greo✓a/p 04/ 7oP oL G'.Pccwo
174 WA rc let Pel2c i 7 7R.trA!._f.N...F..i{.c Fie/S? 3 '1 = 270..a.era...P_,427.0 ar
U 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.
Date
Date
Date
Application Approved By
Application Disapproved for the following reasons•
Permit No
Issued
Date
ECK OR FILL IN WHERE APPLICABLE
No 7Gd
Faa.1—S6B
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Application for fBinpnnat i i nrks
anatrnrtian 1Prmtt
Application is hereby made for a Permit to Construct (' ) or Repair
System at:
an Individual Sewage Disposal
t/ T'
�Lw. onss t or Lot no.
O 1nlel
Im
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures
Design Flow gallons per person per day. Total daily flow
Septic Tank—Liquid capacity1)-56t gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area_.J.&OE&_sq. ft.
Seepage Pit No Diameter Depth below inlet
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
Address
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
gallons.
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
Total leaching area sq. ft.
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 boa IQf health.
Application Approved By
5.1.91-3
late
Application Disapproved for the following reasons'
rr// p. a Date
Permit No..r6.il Issued `.LStYi..�..Qt...�..{..7-,1
( Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF .. . _ .
firrtifirate of fdmnplianre
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.6 4;.6'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
{ I ear
U
flispnsttl or Irks Qionstrurtion 14 rrwit
Permission is eby granted 4�..f .,c4G.4., I
to Construct ( ) or Repair t( ) an Individual Sage Disposal System
at No ,...p.2 'Ii / . . I. ,a.0-.v+r✓
Street
as shown on the application for Disposal Works Construction Permit NO.S.F. ` Dated....::;_: .:;:.,_j.d,...l-/.-:: `
FEE..i:.5..,.-GQ.....
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/%/ of /U2/ ZN_/////N a/
Application for 3isposal r,arks @Qattstrurtion Urrmit
Application is hereby made for a Permit to Construct
System at:
7/1 7./9•C 4/../ ''4.e:
Location.Address
Owner
Installer Address
Type of Building Size Lot°?f../ 12 Sq. feet
n Dwelling—No. of Bedrooms 51-- Expansion Attic ( ) Garbage Grinder ( :-r
a. Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ' )
Other fixtures
tlyy• Design Flow J'—f+' gallons per person per day. Total daily flow ¢60 gallons.
W Septic Tank—Liquid capacity/2-4k.gallons . Length/a.La" Width S'—¢" Diameter Depth /a"
z. Disposal Trench-No ¢ Width..,$'-d" Total Length Zoo Total leaching area $A.O sq. ft.
• Seepage Pit No Diameter Depth below inlet Total leaching
z Other Distribution box ( ) Dosing tank ( ) //
Percolation Test Results Performed by,L94€7'r- ./7r-47:4s'T!_. i 'C.:.. Data/.
,..1 Cittlou7 Test Pit No. 1. ' ' minutes per inch Depth of Test Pit/s-f •^• Depth to ground we/ter /'r -O
k. 4 c-Ayk Test Pit No. 2 •'- minutes per inch Depth of Test Pit/a- - •t v Depth to ground water N'aro6
F4
0
(✓) or Repair ( ) an Individual Sewage Disposal
ety
k /FL6N Af/Ar r Lre. zii7'/i4/2/.P/13*/
Address
7y—
Description of Soil./=-0 Z4i?.F.ki.4e.., /�a` 5/4-7, ''a" •.C4vct /a a Jsht/O
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
Date
Date
Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
No..Lz 0 c
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Applirutinn fur JislannaI 3iNnrke nnntrurtinn Permit
FEE/_S01
Application is hereby made for a Permit to Construct KOr Repair ( ) an lndirAnal Sewage Disposal
System at:
or Lot Not
Address
rInstaller v J Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms y Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No of pool. Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow -67) gallons per person per day. Total daily flow 1/4,el gallon,.
Septic T:.nk—Liquid capacity/625.0w lions Length Width _.. meter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft.
/Seepage Pit No Diameter Depth below inlet Total leaching area/ode rq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results „„ Performed by Date
Test Pit No. I 4.- / minutes per inch Depth of Test Pit Depth to ground water_/flfl2
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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ,s�su`ed.by the board of he th.
Application Approved By S4efrientti
r
Dac
Application Disapproved for the following reasons-
Permit No.__6 °Z'
Issued o ,2 JbeJT
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
of
(Eradicate of (Eamptianrr
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 a.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
`t
Bispasal arks atonstrurtian Wand
Permission is ereby granted r 'S
to Construct ( ') or Repair ( ) an Individual Se eyDispcpal System
at No
FEE nd
street r
as shown on the application for Disposal Works Construction Permit No 4 Dated
Board of ereh
DATE
FORM 1255 HOHBS P. WARREN. INC.. PUBLISHERS
7j-
No Faa..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
g
A}+plirtttinu for Elispnsttl w trim s eattotrurtifiti Permit
Application is hereby made for a Permit to Construct (i,/ror Repair ( ) an Individual Sewage Disposal
Sys at: / n C ADO }
2 . thar.%7..ag.11l2..1._...A O /^ 0 7
Loc o -.addma
al GLE, --/42/2.La..No
.. . ' tJ
c/
zeta;
nInstaller Address
Type of Building Size Lot..2 tO Sq. feet/
Dwelling—No. of Bedrooms 4— Expansion Attic ( ) Garbage Grinder (j 1
a111 Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
f— Other fixtures
Uri Design Flow gallons per person per day. Total daily flow .gallons.
rL y Septic Tank—Liquid capacity gallons Length Width Diameter Depth
x4r" Disposal Trench—No Width Total Length Total leaching area sq. ft.
3
Al Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
• z 'Y. Other Distribution box ( ) Dosing tank ( ) AA -7
.7 Percolation Test Results Performed by./.�..✓li :V L1Jt.17eil,A/6z,CDate_ X-9 .l5
,..1 Test Pit No. 1 U,&!lminutes per inch Depth of Test Pit...efQt / Depth to ground water
k. Test Pit No. 2 minutes per inch Depth of Test Pit...& -6.._ Depth to ground water NOAJE
o I• 11 Description of Soil.._LO a arS7...4 5 iLj"i. .L f. erT/d�lE...s`;S/10 [1.-Q s� -,_agaUr4
W t3t-7" n.i.th atsin $'z tiv ;r,..r•_ee-- !
x
, U fQ Nature of Repairs or Alterations—Answer when applicable
•
3 Agreement:
• The undersigned agrees to install the aforedescribed Individual Sewage Disposal S sts
gn gr ewag po y .`. '1rxoT 'wfth
1 the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to pritethe System in
Ioperation until a Certificate of Compliance has been issued by the board of health.
1
i W
{it Application Approved By
a Application Disapproved for the following reasons
7
Signed
Permit No
Date
Date
Data
Issued.
Date
CHECK OR FILL IN WHERE APPLICABLE
No.—a-'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
OF
FE:ea•er-)
l4ppliratinn fur flispuuat 3 nrkn (IInnatrurtinn thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: t
we ;
Installer Address
Type of Building Size Lot 1/. S. / 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 capacityfaVgallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft.
Seepage Pit No D-" Diameter Depth below inlet Total I thing area..7S2% Oin --
Other Distribution box ( ) Dosing tank ( ) Q
Percolation Test Results Performed by /k �f !LL.1 Date_..S`?' cif-3
Test Pit No. 1 at(2 minutes per inch Depth of Test Pit .0.-s / Depth to ground water flei n
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliant s be, is ued y the board of health.
Sign j J �
gP1Ze
Application Disapproved for the following reasons
Application Approved By
Permit No 1/
Issued %/.!./.II.,.7
note
Date
by
at
has been installed in ac dance with the provisions of TITLE 5 of State Sanitary Code d scribed in the
application for Disposal Works Construction Permit No /4"Y.e dated 7 i ti 73
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN TISFACT RY. /7
DATE tl�1-1-�Fry Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
NN OF
rrtifiratr of aromplianre
THIS IS TO CERT7F at the ividut Disposal System constructed
Q /
) or Repaired
)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD� OF HEALTH
OF
yispnsal np
Permission is hereby granted
Construct (L/f r R it
ion Permit
to C ).atIndividual Sews e isposal System
Street
at Nod
as shown on the application for Disposal Works Construction Permit No
DATE
7/tt 13
FORM 1255 A. M. SULKIN, INC., BOSTON
AA
FsE �is a)
ERE APPLICABLE
CHECK OR FILL IN 1
No FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF / nt 7HEALLTH
(Jl�v OF f�iFF _Yit)
Application for Dismal le urns Qiunutruutiun 11rrmit
Application is hereby made for a Permit to Construct (VS or Repair ( ) an Individual Sewage Disposal
System at: _
iVe. '_!_tf F, Qt�( S f'_CA� t
— t9S r J
.Sior _TL: sr tc(nTN 1- NItiDA&c,s
)°R2V
Location-Addres or Lot No.
s.&.LATI..: - f .3"L- t.: Cv�....t.%C.2. i3 Pao K D...2I.k.E...._F..L-Q.
Owner Address
Installer
Type of Building
Dwelling—No. of Bedrooms .� Expansion Attic
Other—Type of Building No of persons
Other fixtures ._-!.iS..4_q.s:i.S34 E
Design Flow_..? gallons per person per day. Total daily
Septic Tank—Liquid capacity-` gallons Length Width
Disposal Trench—No. Width Total Length
Seepage Pit No Diameter Depth below inlet
Address
Size Lot/ ' A'c C-Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
flow 4 allons.
Diameter Depth
Total leaching area sq. ft
leaching area sq. ft.
Other Distribution box (
Percolation Test Results
Test Pit No. 1 minutes per inch Depth of Test Pit pth to ground water..&
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
C rs sr �ER.F4gMED Due •r-c, ° e/ w._
Description of Soil CrEG fLJl.:..%7....Ni_l4 !_..Fk',_..A
C� — ¢n _ R A Q L:.c c:A) C A-1 4:y - snrue n rcD j - 3 c (le-13
(:c:.a.n'..S_tr 'rG._.J LTn • cid;a...D LU/St 47" -F C4 A-y. ch.=
Nature of Repairs or Alterations—Answer wh&applicable
SEE ix 7-110 gift) —
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 ):.t_ViUtexd.etz, 7!/'✓1 a-/ rte._3 i - (4-7
Date
Date
Date
Dosing e:14,( )
Performed by gYtk 4...i.`�-�.. Date 3 - 3 )
Application Approved By
Application Disapproved for the following reasons
Permit No
Issued
Date
CHECK OR FILL IN WHE
Fas
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Cadyi OF „1
Appliratian0far t3inpnsttl Fr;arks Utx nutrurtian remit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at: jk
Lorstiev•Adiees or Lot No
._.Lia'_;F11,R�.Cti! ." "-'vN^. H) r.^. T(y '-t. .. vr^v✓ ylj./
Address
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No
Other fixtures
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
of persons Showers ( ) — Cafeteria ( )
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity./LQ,Q..gallons Length Width
Disposal Trench—No
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
Diameter Depth
Width Total Length Total leaching area sq. ft.
Diameter 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
Date
Date
Date
Application Approved By
Application Disapproved for the following reasons'
Permit No_......'.
Issued 4 -- "t '. ..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
rt.-Miter at Tompitatirr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )(,) or Repaired
by
Installer
at tat let.1•1 V .1'4' /.0 ...t2 0'
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 ...t; dated it - - 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
104;t:, OF ti" L'ItictS-FH.4121 j
No.. ..:, `.-14 ri- FEE
:I
latgilang IN arks Tanutrurtinn Permit
Permission is hereby granted •-r- ' .d_Litok-icf-t
to Construct ( 1 or Repair ( ) an Individual Sewage Disposal System
at No 'Lae --it.4:-..rat.d.,,/ L:,.Z )
street
as shown on the application for Disposal Works Construction Permit No...:it...4 9 Dated Ce - ,,,',? ' 6' 7
S
DATE
FORM 1255 HOBBS & WARREN. INC PUBLISHERS
Board of Health
CHECK OR FILL IN WHERE APPLICABLE
N0..fl FP?
?
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF H
OF
ALTH
FEa._/4CK
Appliratinn for Pthpusal Works (linnstrurtinn Permit
Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal
System at:
Location•Address
Instal!er
Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder ('.-)-
Other—Type of Building No. of persons.... fis. Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 3.3 O gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacityni O.gallons Length Width Diameter Depth
Disposal Trench—No Width Total Length Total leaching area ��ll ft.
Seepage Pit No .. Diameter Depth below inter Total leaching area. a�''a�.ft.
Other Distribution box ( ) Dosing to ) �- __^
Percolation Test Results Performed byl -�= ^r'e-"' ^e`-- Date /3.i/7..
Test Pit No. hal inutesperinch Depth of Test Pit /0 Depth to ground water ---114-0-11.A-..
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
q
Description of Soil 075 O
3:01-if I - 3 .f r' Z
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 TITLE S of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beut by t bo rd of h eal^h.
Application Approved By
Application Disapproved for the following reasons
Sign
��!
by T Q pfc..L7 y(
at `1-1.A.t.( /
has been installed in accordaijce with die provisions of TI'"'r/ 5 of The State Sanitary Code a sibe/ in1the
application for Disposal Works Construction Permit No /..TJ..� dated
�trt!L
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR Na Tee THAT THE
.+ ..+oncTTOSC 11 S
BOARD OF HEALTH
OF lie'
(r rrtifirttte of Qlinmpli nu
he Individual Sewage Disposal System constructed
( ) or Repaired ( )
It II
74.
SYSTEM WILL FUNCTION SATISFACTORY. / r
DATE
tt// ?`/
> ...� ... Inspector
No '/
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH 74C
C_ - OF
Ois}TOnttl F`ajhn o s ian jgrrmit
Permission is hereby granted �'`� ' �
to Construct ( r Repair ( ) an tndi t ai Sewage Disposal ystem
at No —7: .t...✓'. l i. / i t"i"'t ,(cy
Permit / �
as shown on the application for Disposal Works Construction Permit' lot'! J1 Dated
DATE
FORM 1255 /7 ens & WARREN, INC., PUBLISHERS
(.If l'i"'i y
I/ ,/ Board of Healt
FEE /.i' e
CHECK OR PILL IN WHERE APPLICABLE
No._I O
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF deli
OF 3lppliratinu for li pn5ul Works i4nuntrurtinu Permit
Application is hereby made for a Permit to Construct (" ) or Repair ( ) an Individual Sewage Disposal
System at: _ - cl—
'.t i....... nab,
or Lot Na
FEE /-7 t Q c
Jat "er .
Q
[¢stater
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Address
Athfreas
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No of persms Showers ( ) — Cafeteria ( )
Design Flow y gallon, per person per day. Total (lady
Septic Tank—Liquid capaci i527 _gallons Length VV VIM:
Disposal Trench—No Width-3-Q / Total Length—S6
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Description of Soil
flow gallon-
Diameter Delft _ ..
Total leaching erer / h 6x9 t:.
Total leaching are sq. f:.
Performed by Date
minutes per inch Depth of Test Pit. Depth to ground wate
minutes per inch Depth of Test Pit Depth to ground water
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 iss d by tl lfrard heal;
Siened,
Application Approved By
aJ1 t ." et
Application Disapproved for the following reasons
/97
Date
Dam
Permit No
Issued
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ... .. . . ._...
Qlrthfiratr of fdnmplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Inviolate
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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF .. ... _ . .
Bi npuLial ,311nrks «nnitrurtinn Permit
FEE
Permission iss herehy granted
to Construct ( L' or Repair ( ) an.Individual Staa age Dispos System
at No j-..T , - Li _1 .j ....-1" 14,e-r24
as shown on the application for Disposal Works Construction Permit No Dated
Hoard of Health
DATE
FORM 1255 HOBBS a WARREN. INC.. PUBLISHERS
-StrrIrrneir •••• ••••111
)
No 77$ FEE.J ' U V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
OF HEALTH
Applirtttiun -fur 3jiti{fumttl Iliurku Qiuntitrnrtiun lirrutit
Application is hereby'made for a Permit to Construct (° ) or Repair ( ) an luditidual Sewage Disposal
System at:
11044.:I '4
ycs
Address
Type of Building Size I.ot Sq. feet
Dwelling—No. of Bedroomr Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of person. Showers ( ) — Odeteria ( )
Other fixtures
Design Fk w `._6
gallons per person per day. Total daily flow gallon>.
Septic Tank—Liquid capacitK d0-h'll tns Length Width Diameter — Dept''
Disposal Trench— No AA idth.ol-Q Total Length 9.61 Total leaching aaa_2Q Q msq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching:r•- aq- IT
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by__--_. . Date
Test Pit No. L minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 J......_minutes per inch Depth of 'lest lit 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 accord -e with
the provisions of Article NI of the State S o'ittry Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued by the bard of health.
Signed l. ' .I'
Application Approved By � -`F-1-' !eU
Application Disapproved for the following reasons'
'71977
r.4
Permit No._..77.7
Issued 7,._i f- F
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Trrtifirate of klnmplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
)
m=tan«
at
11as 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 111
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
fJiopoo4 Marko Uonotrurtiott lrrmit
Permission grnerehy granted C.-)ps■ t.0 �.Y(Q f�=
to Construct ) or Re ( ) anyndividual e Disposal/System
at No :.f ka 3-01 on J
as shown on the application for Disposal Works slnxtion Permit Nar . Dated t--
ri
7f tr
Board
DATF . . .. ... ... . . .. . ___ __ . . . __ ._
FORM 1255 Hoses s WARREN. INC.. PUBLISHERS
Ns,
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
FEB..,(.. D I
BOARD OF HEALTH
"
Apptirntinn fns` ilispnsnl 11 ,nu�rl,,Tnnstrurtinn ¥ermit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System at: G�.� � �� C� ����jj
iern :ii.f.dddress aQ�A'
-/Address or Lot No.
Address
vrtaller 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
Septic Tank—Liquid capacit/..54Q.0gallons
Disposal Trench—.-No. Width
Seepage Pit No Diameter
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
per person per day. Total daily flow gallons
Length Width Diameter Depth
Total Length Total leaching area
Depth below inlet Total I eac m h' area
sq. ft.
s a. ft.
lage
Dosing tank ( )
/ofl
rent
Performed by Date V
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 TITLE E 5 of the State Sanita ode—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hale ed by t . f health
Signed_t 4 1 ?E
1 �yJ ge F0
Date
Application Approved By
Application Disapproved for the following reasons•
Permit No..p 9 y Issued.
mt
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(2rrtifirate of fdnmplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
at
has been installed in accordance with the provisions of TITLE 5 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.
DATF Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
flinpnnat Moritz Qlnnotrnrtiun hermit
FEE. :
Permission is hereby granted
to Construct ( ' ) or Repair ( ) an Individual Sewage Disposal System
at No
sleek
as shown on the application for Disposal Works Construction Permit No Dated
Board of Hearty
DATE
FORM 1255 HOBBS 84 WARREN, INC.. PUBLISHERS
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
rrtifirate of kinmplianrr
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 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.
DATE Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Jiupusal jVnrkn Cnunstrurtinn Permit
Permission is hereby granted - ,i
to Construct ( i-)or Repair ) an Individual Sewage Disposal System
at No f
sore
FEE
as shown on the application for Disposal Works Construction Permit No Dated -
DATE
FORM x255 ROBES & WARREN. INC_ PUBLISHERS
Board of Health
The undersigned agrees to install the aforedescribed Individudf ewage Disposal System in accordance min
the provisions of Article SI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i sued b the boar of hQalth
Signed Q y
Application Approved By
Date T-/ i
nom
Application Disapproved for the following reasons'
Permit No.....p..pr
Issued
Dam
a 7../
Dale
CHECK OR FILL IN WHERE APPLICABLE
No F57 FEe 4.77.P6
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF /[r t2let A65.0?)
Appliratirm fnr fin}unal I urkn Cnnnntrurtinn Prrmit
Application is hereby made for a Permit to Construct
System at:
f4Hp4
..14V
or Repair ( ) an Individual Sewage Disposal
��..y, �ry �y�.A or Lot No.7iaide
/J oxg "laic 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
Septic Tank—Liquid capacityu.fl0 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 sq. ft.
Depth below inlet Total leaching areq/&Q.4 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:IT L. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee is ued b the oardA / 1 of a� lt�h�.
4? /
Signed_.!!" " ( [~
` / s o�m
Application Approved By ,Sa,} ._A. -d!t_LQIf
I _ 000 natP
Application Disapproved for the following reasons'
Permit No..
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
f2rrtifirt r of aiumplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
has been installed in accordance with the provisions of TITLE 5 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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF '
No — FEET
Disposni
)i
arks QIonwtrnrtion jrrmit
Permission ism hereby granted - / /1,
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No 7.1.: -t.- --
street
as shown on the application for Disposal Works Construction Permit No Dated
DATE
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
Board of Health
CHECK OR FILL IN WHERE APPLICABLE
No...l..9{/i paulL5j.( C
THE COMMONWEALTH OF MASSACHUSETTS
,( BOARD O0ALTH
C�LI,y OF U
Appliratiun 'tar f- ispnzul illurks°Cllimtrurtinu jirrinit
Application is hereby made for a Permit to Construct (*) or Repair ( ) an Indic idual Sewage Disposal
System at:
7347114- 2/
oea,; (of,
Ater 'L N .4Q--
addrecr
Installer Address
Type of Building Size I.ot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of penman Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total d2ly flow gallons.
Septic hank—Liquid c Ire tjiide g (Ions Length lF idth D ameter Depth
Disposal Trench—No. Width..A{/! Total Length_ /4/ Total leaching area__g'Q4 1. It
Seepage Pit No Diameter Depth below inlet Total leaching area
Other Distribution hox ( ) 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 aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article N1 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee _ sued by the board of health.
Signed �Q{j-✓^-!!
mm� y�. / 77
Application Approved By ./ _i..s - -, n.. AJ�G., 7 `9/ /
i Date
Application Disapproved for the following reasons'
Permit No._.,/...�f..4i
Date
Issued_ ag2(2- .-, 9 /977
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
hlrrtifiratr of Tomplianrr
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 ('�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
BSpaEaI Works Qlonstrurtion firrutit
Permission is erehy granted
to Construct O/ or Repair ( ) an Individual Sewage Disposal System
at No )i ✓
5 !n
as shown on the application for Disposal Works Construction Permit No % Dated
r-' Baat4 o Health
DATE
FORM 1 255 HOBBS & WARREN. INC_ PUBLISHERS
y
HERE APPLICABLE
CHECK OR FILL IN
No . 53
THE COMMONWEALTH OF MASSACHUSETTS
FEE /ST 0 0
BOARD OF� HEALTH
CLACLI(y OF ��
Apptiratinn fur Bis#Inzat Marks Cnnnstrurtinu 'rraut
Application is hereby made for a Permit to Construct (r') or Repair ( ) an individual Sewage Disposal
System at: 2T
ar ..� ams
k�l
or Lot No.
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No
Other fixtures
Address
.Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
of person. Showers ( ) Cafeteria ( )
Design Flow 541 gallons per person per day. Total daily
Septic 'lank—Liquid capacity a4Ogallons Length Width
Disposal Trench—No. Width._r .n Total Length.._Ve
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1_-] 0 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
now :AO C canon..
Diruneter Depth
Total leaching area ...2-0a sq. ft.
Total leaching area sq. ft.
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 as- ed b the board of health.
Signed .9 `Zt.) ,t-re-A..
Application Approved By
91Ey.4 ,y7
Application Disapproved for the following reasons•
Permit No.
6.5-3
Date
Issued.
�//�/, � � p 1_97..J..VA'V 3 '
Date1
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
rrtifiratr of Tnmplianrr
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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Jiapn.ial illnrks Qtnnstrurtiun tirrittit
FEE
Permission is hffeby 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
Board of health
DATE
FORM 1255 HOBRS a WARREN. INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No c/o2 Fr
THE COMMONWEALTH OF MASSACHUSETTS
CA-jBOARD OF HEALTH
Li(tr OF
.Application for llinpu at Works Q nnstrnctinn rrmii
Flue...._.
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System at:
Localt�� eas or Lot No.
ills?-' aY.L(.f�
�l Dsyner Address
tbilil a.
Installer Address
Type of Building p Size Lot Sq. feet
Dwelling—No. of Bedrooms .1 Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow S12.T. gallons per person per day. Total daily flow .3 0 / gallons.
Septic Tank—Liquid capacity. 6D°gallons Length Width T_ Diameter Depth_..
Disposal Trench-No. 1......_.. Width I.7 Total Length c1-5- Total leaching area.__!r/-r4isq. ft
Total leaching area sq. ft.
Seepage Pit Noy Diameter
Other Distribution box 0,) Dosing t
Percolation Test Results Performed by
Test Pit No. I..Jt/ a minutes per inch
Test Pit No. 2...54..1a minutes per inch
Depth below inlet
Depth of Tgt Pit r‘i
Depth of Test Pit &'
Date
Depth to ground water
Depth to ground water.ate'n-e
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 e' sued by the board of health.
/z ye4"
Application Approved By
Application Disapproved for the following r-i. ons
Signed °(
Permit No...oZ�._a
Date
Issued.... t.. /.9A
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
it4 OF ri„-te.c--ck MIMTjA5,1
Oltrtifitat? of tgoit*Itatut
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( /or Repaired (
by tc. 4:it,4
t r cut itt-rriit"" "Instinct
at f 4?-if It„
has been installed in accordance with the provisions of AI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No r; dated 77ry 9
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE \„447 4t Inspector L.,vitr?'.,4.,
of' 'Prirrer
NO 47.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
et.47L. OF ; /Tr&4:r; I L ffirii
Biopitsai orkg Oinnotrurtion tirrtitit
FEE
Permission is ereby granted H1T tr t‘,IM 0'4
to Construct ( y or Repair ( ) anInEvidual Sewage asp° yst
at No
-1"?Yr-4 % 4T , -a
as tiernk • street
as shown on the application for Disposal Works Construction Permit No Dated tit:el, 4
DATE 1Ltr., V
FORM 255 HOBBS & WARREN. INC., PUBLISHERS
Aoard Of?'dealk '(-
Nt5--7Y
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City of Northampton
FEB„ aS
tttinn for Bi ipootti 3nrks Clonotrurtion hermit
cation is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
...WD..it11..F.arms...Ro d
Location-A
Lgwej1..b'aison_
Tacy Construction Ow"`
Installer
Type of Building
Dwelling—No. of Bedroom
Other—Type of Building
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity.150f1gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft.
2,5
Seepage Pit No 2 Diameter Depth below inlet Total leachingarea-capacrt syq. ft.
Other Distribution box ( ) Dosing tank ( ) 1242 GP.D.
Percolation Test Results Performed by RPB Huntl¢y. AS.&oa Date....3-21-.84
Test Pit No. 1 2.0 minutes per inch Depth of Test Pit 6'6" Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit 11'0" Depth to ground water None
orEttIvo.
Buffington Dill Road, Worthington
Address
Maple Street, Florence
Address
Size Lot 14 AC —5-Veer
4 Expansion Attic ( ) Garbage Grinder ( X)
No. of persons Showers ( ) — Cafeteria ( )
440
De3rtription of Soil Deep hole #1, 11'0" deep, no groundwater, 11Q" QTS.__1'.0.:!.silt,
U0'', silt and V.F. sand, 2'0" M-C sand and F. gravel
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 TIT 1-1.2 5 of the S itary Code—The undersigned further agrees not to place the system in
operation until a Certificate of mplianse s beenriagued t e boar of Ir lth.
ZAAft
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CIT`or NORTHAMPTON
(gm-tartar of (Qomplinnrr
THIS IS TO CERTLEY, That •e I"ndi-'i. Se.�i,e_Dispged) System constructed (t -ar Repaired ( )
at
by
�k)( -et-' nstaller /% iL w/ a
has been installed in accordance with the provisions of TI 1 LE__5 of he State Sanitary Code s escrl ed in the
application for Disposal Works Construction Permit No dated 'V 3 1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU CTION SAT,C�pJ(�(�TpRY. ,
DATF ,/_. •2 1 "L Inspector '
No "ge.
THE COMMONWEALTH OF MASSACHUSETTS
C CITigOAR-641tilThMi4MTH
CIT`bF__NORTHAMPTON
FEES• '0D
Utopian( Ilporkn (ltonstrurtion ermit
Permission is hereby granted -cFy.trati t-G+•""-- L4"x'- - '� t-
to Construct ( y)'or Repair ( n) an Indiyi ual Sewage Disposal System r
- at No 1•,11:1t1-41-+. �j/.LU. c 'ff..a i1.l..ti.Llt YG•q..w, /`��
Street Yy f/3/7Y
as shown on the application for Disposal Works Construction Permit r .. Date
DATE
oy
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
0
Pon
THE COMMONWEALTH OF MA5SACHUSts11S
rA` BOARD OF HEALTH
CITY of NORTHAMPTON
Y
}I}Iliratin22 far 7iII}ul,ai iDnrks (!tw wtrltrtinn L.Irrutit
Application is Imreby nude for a Permit to Construct ( X ) or Repair ( ) un ludit ideal Sewage Disposal
System 4:
North Farms Road
David Morse`uea"'"'Ad'Ifese
Owner
1"etller
26 Washington Aviefflt9; Northampton
Adduct,
Address
Type of Building Size Lot 4Q ac•+
Dwelling—No. of Bedrooms 4
Expansion Attic ( ) Garbage Grinder (x )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 50 gallons per person prr day. Total daily 'low It'00 allons
b 1500 rs 1 P P Y• Y g•
Septic Tank—Liquid capacity gallons Length Width Diameter
Depth
Dispo::al Bed —Nu._...I............... \iridth.30' Total Length 4Q Total leaching area 1 200 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. h.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by RPB--Huntley Associates Date 5/3/77
Test Pit No. 1 8.0 minutes per inch Depth of Test Pit 31-8a Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pi• 10'-0" Depth to ground water 6'-0"
Description of Soil
2" OTS, 5'-10" Sand and gravel with a lot of cobbles, 4u-0" sandy clay
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribcd 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
Dare
Date •
Application Disapproved for the following reasons•
Date
Permit No Issued.
Date
CHECK OR FILL IN WHERE APP
Y
_I
No ^i..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
of • :�z - .,.rte .
FEE
Application for Disposal Works flonstrurtion Permit
Application is hereby made for a Permit to Construct (' ) or Repair ( ) an Individual Sewage Disposal
System at:
or 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 -✓0 �. gallons per person per day. Total daily flow d 0 0 gallons
Septic Tank—Liquid capacity . 'W gallons Length Width Diameter Opt
Disposal Trench—No. Width Total Length Total leaching area -" 0 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results e 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
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
ate
Application Disapproved for the following reasons•
Application Approved By
f
Date
Permit No ! Issued_ ' '-a i
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
fdertifiratr of Otnmplianre
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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH Lift
OF . ''-`T"t� ir 4�
flis#Insttl,.
Permission }ynereby granted ''s '
to Construct ( >)) or epairj., ) an Ipdividual Sewage Disposal System
at No
rr,
vas_ onntrurtion lJermtt
FEE
street
as shown on the application for Disposal Works Construction Permit No.. Dated ilf''
.�Bozd of HW[6
4141
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' )y OF '(. � 7-7- 14 )3h 117Oi1.1
Application for Mammal arks Qlonstrurtion l3rrmit
Application is hereby made for a Permit to Construct ( v) or Repair ( ) an Individual Sewage Disposal
System at
!ir''C T±t F/? f, t( S
Location•Address
T u FFN Lott JA)e-
e_4. 0 T ZSZ in Cr.r,-/% eF IS 77-1=6- F79c)-( LiuOsE
Owner
Installer
of No.
yc: T y FHl2 jAd £.4.f2-
Address
Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms L Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fix res
Design Flow 5 O gallons per person per day. Total daily flow Arlin ZOOgallons
Septic Tank—Liquid capacity_I I gallons Length Width
Width Total Length
Diameter Depth below inlet
Dby.n ( )
Performed by... 'mc,Qd
minutes per inch Depth of Test Pit `f'3 n
minutes per inch Depth of Test Pit
Disposal Trench—No.
Seepage Pit No
Other Distribution box ( )
Percolation Test Results
Test Pit No. 1._Z.Q
Test Pit No. 2
Description of Soil.
Diameter_.._._ ... epth
- Total leaching area_. ..5.0 sq. ft -nti-n
Total leaching area sq. ft.
Date `f- 'y L -4c-7
epth to ground water -rset -w—.
Depth to ground water
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.
„M...LI U . -j..e-t C2 _.�i H .4
.1 -L,7
3 Date
Application Disapproved for the following reasons
Application Approved By
Signed.
Permit No
Date
Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
No
C
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
OF ,!C1... .11..7+1
Application or Disposal Moths
unstrurtinn Vrrmit
Application is hereby made for a Permit to Construct ( or Repair
System at:
A. _ TEEM la ffia),
Locate
Ow
(ij , c . 2, c: inei
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 ( )
6-
an India idual Sewage Disposal
Other fixtures
Design Flow gallons
Septic Tank—Liquid capacity gallons
Disposal Trench—No Width
Seepage Pit No Diameter
Other Distribution box ( ) Dosi
Percolation Test Results Performed by
Test Pit No. 1._.2zraninutes per inch
Test Pit No. 2 minutes per inch
Description of Soil.-1"b.
SY e
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.
Depth of rest Pit
Depth of Test Pit
Dateail`/Lc.
'Bepth to ground water.2ate&a.E
Depth to ground water
6- C.
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to
operation until a Certificate of Compliance has been ssued by the board of health.
Signed...
Application Approved By
Application Disapproved for the following reasons'
in accordance with
place the system in
Er 30 -ca7
Date
Permit No
Date
Date
Issued
Data