Lot 6 (167, 172) Title 5 Applications/Permits Soil Survey 1996 Performed
Commonwealth of Massachusetts
Alor
, Massachusetts
Date . Z] 9(p
Site Suitability Assessment for On-Site Sewage Disposal
By Ailmilliew S0k eo
v
Witnessed By. Pe+rr M f E-rinirl
Certification Number.
I
Loath Address or Lot No. LOT # 6, FtorovEnLy
/GCo/toat As e-or >s 2v NaRTM PAU1S f
Owners Name.Address and Tats (9 17) -534 - I g 71
KEVIN I)EA,PY
R
/97 NOTH mddPR,e ST
NorzrNAmpmp) MA 010(00
New Constnution t(
Office Review
Repair ❑
Published Sail Survey Available:
Year Published /971
Drainage Class C.
Surficial Geologic Report Available:
Year Published
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map.
No ❑ Yes
Publication Scale I /5840 Soil Map Unit Pc S
Soil Limitations SEvSR E : ?ERC$ sww t-Y
No Yes ❑
Publication Scale
Above 500 year flood boundary No ❑ Yes P(
Within 500 year flood boundary No * Yes ❑
Within 100 year flood boundary No)s( Yes ❑
Wetland Area.
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): /99(0 Month Suly
Range' Above Normal It( Normal ❑ 0elow Normal ❑
Other References Reviewed:
O. S. G. s, Tornc4RArNcAL- MAP
z
On-Site Review
Deep Hole Number 2 -I Daze G(21 /9% Time /1 90 Weather Snr/ 750
Location (identify on site plan) SEC Sitattf
Land Use woo OS Slope (%) 3% Surface stones /4-104.1a-
Vegetation l Z5oLM 5
Landtorni DP°nl Li A)
Position on landscape (sketch on the bads)
Distances from:
Open Water Body 7/00 feet Drainageway 7/00 feet
Passible Wet Area 7/00 feet Property Line 7Z 0 feet
Drinking Water Well >/00 feet Other
DFFP OBSERVATION HOLE LOG
Sad Horizon
Sail Tenure
(USDA)
Sod Color
(MUnsell)
Sad Mottling
Other
(Smrmn,Stones, Boulders.
Cansistenc .%Gravel)
Depth from Sadao.
(Indies)
— /
low- ZgW
I
28 - 34
3 '� - San
<I
4o" — qg„
9?' — Iza`
r
S C
C 1
Cz
Ca
sl-
S L
rsM o
34Ioel,
Na � 4
5H loati-.
TS YR 2. z.
/0'/R 9/Q
!!��
77Yi13
10VKs/3
Z.S)/ 5/3
25Y 313
--
LWsz=, FRIABLE-
mAss uE
�4SSW€ FRIABLE
Sn5ie Gra(,
too
�lKmr ,nASru-€1
C, u+, r3.
G s 2 2o'3°%
mNSLt , zo°/G-.-el
nRA\
3 "
SY2
lovlt(n(G
w
5%
3/3
Parent Material (geologic) "ftenlac;ct O” CIS
Death to Groundwater
Standing Water in the Hole: 85 Weeping from Pit Face: �5
Estimated Seasonal High Ground Water. 35°
3
On-Site Review
Deep Hole Number 2 -2. Date 2/<7/W0 lime IV ;0 Weather5°e./ 75°
Location (identify on site plan) I
Land Use Coon-Ilan al s Slope (%) 37n Surface stones ti oA/F
Vegetation /14 rro/Solo- wood r
Landform D2um L/.V @ Ef)cic
Position on landscape (sketch on the bads)
Distances from:
Open Water Body ?/0-0 feet Drainageway %/G'J feet
Possible Wet Area 7/OD feet Property Line >20 feet
Drinking Water Well _ ?/Co feet Other
DPP? OBSERVATION HOLE LOG
Depth from Surface
(inches■
Sad Horizon
Sod Inoue
(USDA)
Sod Color
(MUnaed)
Sod Morning
Otter
(Strucun.Stones. Souoan .
Comic moy.%Gravel)
0 - 2 '
„
2 - 2 0
20 3 '
4
?q - d
56 rr— / 0 4 u
A
f3w
C
�'
Z
�3
S L
s /—
ScnQ
SlE} L
S2n1 Loam
/OM 5(3
/o Y i 9 9
25 Ys/
25 r4
2.5Y1/3
_
/4 AS67 fR/A B/
MA.3511T FZar &
,1605
niEb 'rams
LGOS(._) !os ernxct
�Ye--ciLa,fl,es,�mri •
ra�I ,fin,,V015/
20 to coli-I (r
tr.:1- /L4Y2SS oT
Sri Qrcatc
39y
75y
I5YRs]co
Sb/0
4/2
I
Parent Material (geologic) -C'r,.y 1,/I
Depth to Groundwater. Standing Water in the Hole: 9i Weeping from Pit Face: 9�
t1
Estimated Seasonal High Ground Water.
3 9 '/
i
Determination for Seasonal High Water Table
Method Used:
o Depth observed standing in observation hale inches
❑ Depth weeping from side of observation hole inches
)5t Depth to sail mottles 35- inches
o Ground water adjustment feet
Index Well Number
Reading Date
Adjustment Factor Adjusted Ground Water Level
Index Well Level
4
Percolation Test
Date: 6/2 7/7, Time: //9(P
Observation Hole 4
2 -/
I 2- 2
Depth of Perc
95'
Start Pre-Saak
//:96,
/ 2:5/
End Pre-Soak
/2 6/
1 ;66.
Time at 12°
IZ ; 02.
L0 %
Time at 9•
12: 05
1 . 15
Time at S'
12: 0q
1: 24
Time (9-- r)
4
%
Rate MinJlnch
1/3 min/�n
3 ro1in
Site Suitability Assessment
Additional Testing Needed:
Performed By: YY! eij
Witnessed By:
Site Passed Site Failed ❑
Comments:
Certification Number.
tea«
Location Address or Lot No.
FORM 11 - SOIL EVALUATOR FORA
Page 3 of 3
(o FORmERLy REcoRbEU ac Lot' itZ
AJORTh RARmS RD fOR reianrro.v
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole....... inches
❑ Depth weeping from side of observation hole inches
® Depth to soil mottles 35.__, inches
❑ Ground water adjustment feet
Index Well Number ....... ..__.. Reading Date _ Index well level
Adjustment factor . Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? YSs
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 6/ze6 (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature i1�i7tiol.c.> �t oyY Date 61277U0
DEP APPROVE)FORM-11107195
Almer Huntley Jr, & Assocs. Inc.
Surveyors - Engineers - Landscape Architects
30 Industrial Drive
NORTHAMPTON, MA 01061
(413) 584-7444
J
`? — l3/ 1 r !Sevin yeofey
SHEET NO
CALCULATED BY MSS
CHECKED BY
N T S.
SCALE
OF /
DATE V*U..
DATE
1=U-F4'
TEST PIT2
e
PE IC Z_
LDT4
F 1=57-PIT
[FAIL]
N
❑ \
N
NO STN FARM 13D
1
GRAVEL
ACCESS
UP 39 /90 LIP 35 / 91
NO IL LOT NUMBERS CHOI,VNAI< rI/FFFkrr
Almer Huntley Jr. & Assocs. Inc.
Surveyors - Engineers - Landscape Architects
30 Industrial Drive
NORTHAMPTON, MA 01061
(413) 584-7444
,oe 9 C' - 131 fo
Ilevin i{c. y
SHEET NO 1 OF
DATE Ii//3/q(o
CALCULATED BY MSS
CHECKED BY
WT.5 .
SC LE
DATE
NOT-E : LoTNVM ?EF5 SHOWN A1E GWENT
Almer Huntley Jr. & Assocs. Inc.
Surveyors - Engineers - Landscape Architects
30 Industrial Drive
NORTHAMPTON, MA 01061
(413) 584-7444
JOB Cka - /3/ Tai lettin Aka-Fe/
SHEET NO IT OF I //
CALCULATED BY MSS CATE /1//3/9(0
CHECKED BY
SCALE
/✓.T S.
DATE
1 NORTH FARM ND,
PEKC
LOTS
N
m
PEI3C Z
OT (o
HERE
LOTS-
COUNTRY 1411=N -t
A11ROX. SOUTH
PER I_
LOT LO
/ 7 3 /
AFTIVOX• WEST Ft-
99'
-J
-TEIPLE PAINT MAR-KS
ON 71TEE ON SOUTHWEST
PROT? Y LIN£
Y (JOTr• LO' UUTBERS SNDUJN ARF Cr/PRFAJT
Name: EASTHAMPTON
Date:9/28/104
Scale: 1 inch equals 2000 feet
Location: 042°20'37.3" N 072°40'28.5" W
Caption: Proposed septic system
Lot#6-N. Farms Rd.
Florenc, MA
Copyright(C)1997.Maptech,Inc.
'HERE APPLICABLE
CIIECK OR PIL
No . ...w FEN -570
0 0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
) pptiratian -far fliapasttl Marks
Application is hereby made for a Permit to Construct
System at:
1)6.77- /rq.{ry -21
4L2.--Yt4- .J- n or Inv No.
uui trurtinu Permit
or Repair (✓) an hidh'dual Sewage Disposal
Installer
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 dady flow gallon._
Septic lank—Liquid capacity_ gallons Length VCidth Ibamete- Depil._.
Disposal Trench—Mo. Width Total Length Total leaching area ,T ft_
Seepage Pit No Diameter Depth below inlet Total leaching are sq. tt
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. I minutes per inch Depth of Teq Pit Depth to ground water .._
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground watc
Description of Soil
Nature of Repairs or Alterations—Answer whe a applicable �y�jR/j`-* `�i - Qx �441
e ate / -/ - . ..
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 bee9 s dQd,lby the boankof health
Application Approved By
vened 1, _f"'i___.ft�.%i-�••-^-
4e1411121- ac- 41-3
Application Disapproved for the following reasons'
Permit No {...p
Date
Issued C0Ff.-S.l99L3
THE COMMONWEALTH OF MASSACFI-
BOARD OF HEALTH
CL17-LA OF 1,1-‘-'751'""c-(("
exrtifirate of Tampion-ire
THISKI,S jO�C/ER J 1 Tha`the,,Individual Sewage Disposal System constructed ( ) or Repaired ( )
by L �.'=e«-. —1... .tkr :Cr.:-.
at Q' � Installer
q i
has been installed in accordance with the provisions of Article Xl 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. CD : v xu
DATP Inspector__ '- /• `N-L✓. t tC+(,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_
OF J 7"
No
�i,nn ttl If urko clnnstrurtiva Permit
Permission is hereby granted ��yye�-� -L-
to Construct ( ) ,or Repair (s.� an Indtidual Sewage Disposal System
at No �JJ street
as shown on the application for Disposal Works Construction Permit No Dated
card or 115911
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
kt1
N.25'03-50
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C ' 1 OF A-16, -rc
APPLICATION FOR DISPOSAL SYSTEM CONS
"Fn
S e UAA:
Application for a Permit to Construct RA Repair I 1 upgrade t 1 Abandon I ] - ❑Complet
FEE
System —I nd ividual Component
• Nor TAhr.I Q.�r�o.
S i EueN Piz
oksrr�a�ae
172h- Frh.ne /2B uc,TArrT.
Adeass
L/I3 — S17-:3a57 LOGO
. Telepnones
Ti.- MA51rN,)
70 /t^ONIA}LEs .(L) WEJIN•-fic.S
Address
y{1) 51-7 1391
1 wnpnn a�
l�i � 6
iDi.
Sara I>A.,-1.iA) TR_
p,r;b
)NC, On AA- c Vb f✓c.•TNfiAC6 .--46C
Amass
et) -In -iti7) CELL_ Cvl7- Oy -117i')
Telephone} \
Telephoner
Type of Building: S ;•v9LF h/{r-IL�
Dwelling—No.of Bedrooms 3 ' �,-PA BA - Asia.nL)
Other—Type of Building
Lot Size a pcnejlSq.feet
Garbage Grinder (a)
No.of persons Showers ( ). Cafeteria ( )
Other fixtures
Design Flow(min. required) -310 gpd Calculated design flow `f 9) gpd Design flow provided H'/ gpd
Plan: Date 5E0, a Y 2° j Number of sheets % Revision Date
Title REL.Sf-s) S. S 1..F-. D;-;5 e v J
Description of Soil(s) S'f-E ?LAN et So. (, (VA I . fpAe-. oPi FIL, BO )1 -
Soil Evaluator Form No. Name of Soil Evaluator f`'yAY7Ne-z 5nKcfDate of Evaluation /- it -91-
DESCRIPTION OF REPAIRS OR ALTERATIONS N/A NFI^' Lo^'=in,JT. -.
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the aprovisions of
TITLE 5 and further agrees not ro� place the system in operation until a Certificate of Compliance has been lesued by the �
Signed - I Yzsti Ov ) Date /
tiE(L Gf- LY- "
Inspections
FORM 1 - APPLICATION FOR DSCP
DEP APPROVED FORM 5/96
No.
THE COMMONWEALTH OF MASSACHUSETTS Fe
-lc)) !. -Kra'i/1/.YBOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑Complete System et
The undersigned hereby certify that the Sewage Disposal System,Constricted(v),Repaired( ),Upgraded( ).Abandoned( )
LtJ i3'1N.
by:
!� p fit 1_'
�) -1.i1 .1�. JY% ZD �Frt-,�L Cy/ r I-ll
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
rS
plans relating to application No. 2 f) dated >cr. : -ON Zbt U Approved Design Flow y i r-(gpd)
Installer
Designer
</1.• , )..;" 1 r U r ..i ; �'I I tom')^— } 1 r/) //
i e �k !t /J(.j ly Inspector //1/ %
t / D // �"A'/-,y
yl ! t., , Date '
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
Na. 9b -4003 THE COMMONWEALTH OF MASSACHUSETTS FEE
Nr t L-/E(Erritl%) BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted tb Construct repair (' ) Upgrade
disposal system at jO/(2%,t-t- U4C ttY
in the application for Disposal System Construction Permit No.
Abandon ( ) an individual sewage
as described
dated :)71-7/2-71.
'2- <-(`7/c.A, iii
r
Provided: Construction shall he completed within three years of the date of this permit.All local conditions must be met.
Date /, /2c/o ? fC'ffE Arnicocl> Board of Health` / / -I -,)01Cr .
FORM 2 - DqSC DEP PPROVED FORM 5/96 �/,^ --- t ,
/ 0 /� L/ _%L fSE.2 f PA) /JGh/Zo oL7) 7/1
FORM 1255 1 R V596/ � / �H&W) HOBBS&WARREN P U ON
5C -2.663
No. —��
THE COMMONWEALTH OF MASSACHUSETTS
n BOARD OF HEALTH
C t-ry OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUC
nphr�ran<„nor a Permit to Omistrust I✓ Repair t I Upgrade I Abandon t ) - Vil'Uomplete System
/1),UO2Z14- !` s lick-0
11--/r4nesk
Hne_-c4so&-
I.,.a;..1
V enPaa.Ia
AJJnTa
I.n a
-T
lde��p M1p..�nYr'd
Lc
rp_LO_YLNi
rpa
a w0
muJlcr Yrnv
J...
4
3
AJJr es
O%3
c
T.�.e„.,,..
r.aeaagn.,
Type of Building: Pt Iw3de-fit
Dwelling No.of Bedrooms atlf t f
Other—Type of Building No. of persons
Other fixtures
Design Flow (min reg uued)At op(' Calculated design flow 860 gpd Design flow provided
Plan: Date
ri Q Number of sheets 4 Revision Date
Title sv€-r '-1 1-4-i our
Lot Size 22: genfent- Ac.
Garbage Grinder (...<
Showers ( ), Cafeteria (
gPd
Description of Soil(s) SPt4P
Soil Evaluator Form No. Name of Soil Evaluator M.Eiiltao eCe Date of Evaluation 3k-& 2b, 1 999
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
1111E 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
FORM t - APPLICATION FOR DSCP
DEP APPROVED FORM 5/96
No.
Description of Work:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
❑ Individual Component(s) ❑Complete System
FEE
The undersigned herehy certify that the Sewage Disposal System:Constructed( ),Repaired( ).Upgraded( ).Abandoned( )
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. dated . Approved Design Flow (gpd)
Installer
Designer:
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
Inspector
Date
No. cD--673
/ > L/ 13
THE COMMONWEALTH OF MASSACHUSETTS
/!02 !4fi4 %K BOARD OF H EA LT H
DISPOSAL SYSTE CONSTRUCTION PERMIT
Permission is hereby granted to Construe ( Repair ( ) Upgrade ( ) andon ( ) an individual sewage as described
�` 9 - i � In ✓
disposal system at / �_ r. - �•-
' Gr
;-C.7 rl7
r'/ .
in the application for Disposal System Construction Permit No. j C� L ,dated
Provided: Construction sgall he completed within three years of the date of this permit. ll loc. condd p must be met.
11-%% 9 , ll
Date ���-� v / � ����y Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 IREV 5/961 t HEW J HOBS fl WARREN
PUBLISHERS-BOSTON
No....._.....'..—__. Fes
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
0r7Y OF e,f4te/si7/rt1Y%oat
Application for Binomial 1:r arks (ffunntrnrtion Prrmit
Application is hereby made for a Permit to Construct (.4 or Repair ( ) an Individual Sewage Disposal
Systea,at:
Location.Address No.
Owner Address
Ins
Type Type of Building Size Lot •-21,4 Sq. feet
1 Dwelling-No. of Bedrooms � Expansion Attic ( ) Garbage Grinder (a )
WOther—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
{{yy Design Flow _.5,—,:i
gallons per person per day. Total daily flow 1%0 41 gallons.
1C Septic Tank—Liquid capacity/fIC.e..gallons Length?'6" Widths-¢` Diameter Depth.� !4 `
ssZlt Disposal Trench—No. ¢ Width..:''A ' Total Length - .fr Total leaching area z•C'.- sq. ft.
• Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
z Other Distribution box ( ) Dosing tank ( )
�7 Percolation Test Results Performed by....('d/..._Ascrtc....I 4es/de - Date /2 7/7<-.
.] F' -'rTest Pit No. 1z. 7 minutes per inch Depth of Test Pit/S&Ls' " Depth to ground waaterr.dl&S
• ,e s c.T e s t Pit No. 2 / minutes per inch Depth of Test Pith '-r" Depth to ground water *thee."
P4
O Description of Soil./` re P-lc'"r:,,/.'"/` J/t 7 ;-../7 0 ` f/w/C lArtr7)
NNE
W
6 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•
Date
Date
Date
Permit No Issued
Date
CHECK OR FILL IN WHERE APPLICABLE
No 31
THE COMMONWEALTH OF MASSACHUSETTS
el./OA R DOF�{{H EAR H
[d' OF...././LJ.1r[.KQiYy
)i.pplirtttinu far Jizposttl Ifllurk J nnstrurtinn hermit
Application is hereby made for a Permit to Construct
System at:
or Repair ( ) an Individual Sewage Disposal
Ow e" f -& 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 capacit/Q3igallons Length Width Diameter Depth
Disposal Trendy—No. Width Total Length Total leaching area /_Q.d°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. 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 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.
Si �e
d�
(7 � °'' Jam./ r
Date if
Application Disapproved for the following reasons'
Application Approved By
Permit No -53—i Issued.
Date
n.-1 J.I7�
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Trrtifirntr of Tymplinnrr
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. 1._I
Permission
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
[21..€3 OF %.y6.jrA.AdTI7.(.tay
flisposnl; i,orkn Cnnns Vtrnrtinn tirrmit
iereby granted_.....v:cral�.4 --: -T`t�'t'e+
to Constru t ( ) or Repair ( ) an individual a¢f-
e Disposal System
at No .-J.s - terE'*-Lh..- ...Q.KJwn
Street
as shown on the application for Disposal Works Construction Permit Not-.'„y...:j
DATE
FORM 125E HOBBS & WARREN. INC.. PUBLISHERS
Dated .14,