776 Title 5 Application/Permits 1960s-1970s THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
64, or 1 (
Apptiratinn fur Jinpnnat Harks Cnnnstrurtinn hermit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
2 .` F fit
`e k.1
()oiler i-
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 / — Se a gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid cap /d00gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft.
Seepage Pit No 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
Other Distribution box (
Percolation Test Results
Test Pit No. 1
Test Pit No. 9
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—Th mdersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issgg�byoard of health.
Signed L
Application Approved By -s4 nir . /C.
1
Date
Application Disapproved for Mr following reasons•
Permit No
y
Date
Issued (. t• n %f /h k
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF (iPALka It.t
ertifiratr of Qinlltplitttwt
by THIS 1 O CEXTITT, That the Individual Sewage Disposal System constructed ( ) or Repa
{,
by _Ara i1:t,46m L' C ✓ ') : 10-': L.1
at A;i k ;:-gy i c"“ % % "iCoL
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 1? dated j'f
'� � 1 d
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI.LL FUNCTION SATISFACTORY.
D:1TI' ( L'�• hey Inspector =` C`(' i ;:7ti.<aFgefrn
d ( )
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF Cf'-, FEE
ilispnstti 3Jnrks Qtnusirurtinn Perulit
Permission is reby granted_.-- / �'-(-�'ti ti. "`� "`( I'M: CA
to Construct ( )) or Pepayir(( ) an ndntdyal (Sewage Dis s. Smtern
at No /I ns I l /' /-{{+-�-�i
Street )
(/
as shown on the application for Disposal Works Construction Perini/ N{{o t! -----_I Dated
Bo,m or Hadh
DATE
FORM 1255 HOBBS B WARREN, INC„ PUBLISHERS
No.l..l f".
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
exty OF / ' itYwy a '
FEE_
Mppltratinn fur Binpnsal clerks (l[nnstrurtinn lkirrutit
Application is hereby made for a Permit to Construct (KM Repair ( ) an Individual Sewage Disposal
System at:
tt
uoiYPA dk,-e or Let No
ar
b
fe ,'ter 7) , ,' l rf as A caT /ry
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
Installer
Type of Building
Dwelling— No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capa
Trench— No. o�
Diameter
gallons per person per day. Total daily flow
gallons I7ength Width Diameter
Width ° Total Length .5°t Total leaching area
Seepage Pit No Depth below inlet Total leaching area
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
gallons.
d U n sq. ft.
sq. fr.
Date
Depth to ground water
Depth to ground water
Description of Soi
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 —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by the b rd eth alth.
Sued... '1O--' '<,./l- ! 4_e✓ --
Application Approved By aear}-li•i`'t f1 " az z '::5.:`:fr.t.:..D 71i / i •7
Application Disapproved for the following reasons-
Permit No / /
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF t ).C:^((cirt Y1n
rrttfttatr of mpltarirr
THIS IVO CERIIF[' T1,3, the II��ttdividual Sewage Disposal System constructed (V) or Repaired ( )
by C L ---„,..t. . /i-ia .I ll)at U !a
has been installed in accordance with the provisions of Article/g,I of The State Sanitary Cy,,{;e��as�deseribed in the
application for Disposal Works Construction Permit No 17 �"' dated./' -Pt' / 7 / it,L..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM VQLL F NCTION SATISFACTORY.
DATE �'-}6f" of l' %Y�l 3 Inspector -- . . „, .5tlx J-fl.L ed
S
No 1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
pct, OF >/, Ara,LF
FEE
fin}Tnr14 3lUnrks Qlnn�s�t�rLurtiuu rrmit
Permission is hereby granted__,,.: fd'�. > 4 yk"�`a
to Construct) or ;air.( g) a �f dividvat-bewa a is osal tern
at No ` ilnort- i_yrv.1 _ .T _.-_ p1.-St
0
Street
as shown on th application for Disposal Works Construction Permit No ! x Dated —'`-!"'j- y''. ye
Ail At 1/.
➢dvd a( %ShUh
DATE
fret 4'S 'U.
FORM 1255 X09BS R WARREN. INC.. PUBLISHERS
No /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(t-c
Applircatiuu
C OF
I fen?
FEE Th.-37 c 0
far flitipnsul 3ffnrkz (inuawtrurtinu 1irrinit
Application is hereby"made for a Permit to Construct ( ) or Repair (�" ) un 1nt• e. ge L)
System at 7b n d
Type of Building
Dwelling No. of Bedrooms. _ 1 xp:m
Other—Type of Building __ No of peron-
Other fixtures
nl
Size I..ot Sq. feet
on Attic ( ) Garbage Grinder
Showers ( ) — CScteria ( )
Design Flow geller
Septic funk- Liquid capacit) g:ilons
Disposal Trench- -No. AAidd,
Seepage Pit No Diameter
Other Distribution box ( ) Dosing
Percolation Te.t Results Performed hv__
Test Pit No 1 n inutes per inch
Test Pit No. 2 minutes per inch
Description of Soil
e r person per day. Total daily :low
Length Width Ditenet,-
Tntal I..cugth Total leaching:
Depth below inlet Total leaching
tank ( )
Del eh
Date
Depth of Test Pit Depth to ground v..i.� _ ..
Depth of Tc-r Pit. __ Depth to ground evate-
.gallon
Nature of Repairs or .AIterations--q Answer
Agreement:
The undersigned signed rees to instil the aforedescribed Individual Sewage Dt po al Svstem in accordance a{th
the provisions of Article Xi of the State Sanitary t.ry Cod the undyrsigncd further agrees not to place the system in
operation until a Certificate of Contpli:rnce bas been issued by the board of health.
4°c riYc
1
Application Approved Hy
2
Application Disapproved for the fo[fo;oinq rrnsons'
Permit No 7-5-6
Issued
b
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(Eertitirate of QLumplianrr
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
i
�.L ) OF
Dioporlatelflorks (nunutrurtinn Permit
Permiss is hereby g nted�y= a' T
to Construct ( ) or rRgpair ( ) an Individual Sewag Disposal/ System
at No r - ..'I- r —I s6� 7
as shown on the application for Disposal Works Construction Perot 1v0. 1
Dated -///'," s.�.�.1{
, ae,
Buvrd° Health ,
FEEL 4
DATF
FORM 1255 HOURS & WARREN. !NC.. PUBLISHERS
No
THE COMMONWEALTH OF MkSSACHUSETTS
FEE
BOARD
OF HEALTH
OF /o ( I} Tli/r/
i1p.piirattthn fur Dismal liurkn Outtaurtintt ranttt
Application is hereby made for a Permit to Construct (+- ) or Repair (
System at:
;kic fit H Ktt�L_C
1 =
on
.M_13.{. s..5 r catio
Owner
) an lndieidual Sewage Disposal
C R 1-0C. SI.7%)
Installer
Type of Building
Dwelling--No. of Bedroom
Other—Type of Building
Other fixtures
Design Flow gallons per person per day. Total daily flow /c.ne7
Septic Tank—Liquid capacity gallons Length Width
Disposal Trench—No Width Total Length
Seepage Pit No Diameter Depth below inlet
Other Distribution box (
Address
Addrcss
Size Lot_ ____i _!IC-�-5q. feet
Expansion Attic ( ) Garbage Grinder ( )
of persons Showers ( ) — Cafeteria ( )
gallons.
Diameter Depth
Total leaching area sq. ft.
Total leaching area sq. fr.
Percolation Test Results
Test Pit No. 1_
Test Pit No. 2
Dosing4
Performed by-/'$
minutes per inch
minutes per inch
{ Date...GO 943 —6,6...
Depti of Test Pit - - Depth to ground water_.!YS-e!sc.S'-_
Depth of Test Pit Depth to ground water
Description oil --eC4L a -" _
P S a:__Ll .... .
4w7
Nature of Repairs or Alterations—Answer when applicable
�.a.e
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to
operation until a Certificate of Compliance has l ssued by the board of health.
Signed `� 1
Application Approved By L{��u%-e.:1/4- �Y�•-;-,�
Application Disapproved for the following masons•
in accordance with
place the system in
6--z :3 —L-C.
ante
.--ze3 6G
Permit No
Date
Issued
Dale
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i
Terttfiratr of Utnnt tltatue
THIS IS TO LERTIF Y, That the Indiyidual Sewage Disposal System constructed ( ✓ or Repaired ( )
by .1-.wia ytl :.r c' j •I• f•
at 7-7 f, tSsitagi-1
5 _ r gtaue
has been installed in accordance with he"the prqyisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ,>'C.I1.(. dated axae
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE r,c ,(ff _� Inspector...]f -.. ''t�' .'"4-
j"
l
No 7 r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF;HEt H.
L:. CWF .i/r/�-v
Disposal s cjnstrtt i
Permission is herby granted (»
to Construct ( ) or Repair G )p�ail IncRyidual Secs e Disposal System
at No jt pp
Street
as shown on the application for Disposal Works Construction Permit—No r.{ �I7ated
FEE
•
DATE
FORM 1255 HOBBS & WARREN. I NC.. PUBLISHERS
F k< 7
ico,
Board of Health
No... •
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
• . OF <frjefreitilail
Appliratinn far Eispnilal Ifforkg6 (IInnstrurtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,
7_L671�: ittir
!'J Lrca' A C4
.,.f..._... Ile 'Nticdea
1
Type of Building /sfo
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capacity /`Sd�g-allo
Disposal Trench—No Width
Seepage Pit No Diameter
Other Distribution box ( ) Do
Percolation Test Results q Performed b
Test Pit No. 1 Q minutes per in
Pit No. 2 minutes per in
Ct ao- ilia a..
Description of Sol]
or Lot Na
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
ns per person per day. Total daily flow gallons.
Length Width Diameter Depth
Total Length Total leaching area. ..Q.Q.sq. ft.
Depth below inlet Total leaching artn...,.... s ft.
sing tank ( ahion- t1 ro4( ai .Z- V4
Y ! Data
nch Depth of Test Pit Depth to ground water
ch Depth of Test Pit Depth to ground water
rise _ <h., Atstif eft- dai.:.4 niter a..;m..
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 undersi urther agrees not the system in
operation until a Certificate of Compliance has been issued by the boar �lth
Application Approved By
Date
Application Disapproved for the following reasons
Permit No 6
Issued
Dart
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
rrhftratr of CC Hann
THIS IS TO p'ERTIFY That the Individual Sewage Disposal System constructed (✓) or Repaired ( )
by
C lusm�e.
at 7.7.6 Z 4 L
has been installed in accordance with the p visions of Article XI of The State Sanitary
)
Nsposal as described in the
appl¢ation 1 for Nsposai dories Construction Permit No 414 dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
n.....: C. ...,.. fi )tia "7 .