Permits & Applications THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
/ 777 OF 1C % ijTe' A
.Application for Disposal Works (!iunstrurtinn Denzil
Application is hereby made for a Permit to Construct ( t") or Repair
ystem at:
7,C7 Sf/'/A £ p7T[ iT C( A /) - azeLei ? e-
an Individual Sewage Disposal
■ iefl77J
T. aims-Add+vs
Owner
Installer
t
Lo x
S RS 7— ST c"-0ij Cj-/-�f%f//)1'Cif::�
Address
'ype of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No of persons
Other fixtures
resign Flow gallons per person per day. Total daily flow gallons.
leptic Tank—Liquid capacity gallons Length Width Diameter Depth
lisposal Trench—No. Width Total Length Total leaching area sq. ft.
leepage Pit No Diameter Depth below inlet Total leaching
areas,. sq. fa
_ (4 Distribution box ( ) Dosing/tank (i ) / ( ' , ,T e-`,ca.
_
'ercolation Test Results Performed by_.(.._.S_:-LW1.t.a- k-Lr? Date 74; —.A7 �c-' C _
Test Pit No. I ----6— minutes per inch Depth of Test Pit_a.�u s Depth to ground water A ' t E
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Address
Size Lot Sq. feet
Garbage Grinder (
Showers ( ) — Cafeteria ( )
)escription of Soil L t[�/.a..c.1 cad A:2-) ,1 it D s1 L t
dature of Repairs or Alterations—Answer when applicable
)greeinent:
-
The undersigned agrees to install the aforedescribed Individual Sewage Disposal SIlir +inta5eordance with
he provisions of Article XI of the State Sanitary Code- The undersigned further agrees not to pace the system in
Pperation until a Certificate of Compliance has been issued by the board of health.
Signed
\pplication Approved By
%pplication Disapproved for the following reasons'
Permit No
Datr
Date
Date
Issued
Date
t.
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
Application for Disposal 'Docks (nuustrurtion 4lnnmit
Application is hereby made for a Permit to Construct (✓ ) or Repair ( ) an Individual Sewage Disposal
rystem at:
Adana, or Lot No.
r-w
O ro.
Address
.A e i%
CI Installer
Address
'ype 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
)esign Flow ) gallons per person per day. Total daily flow gallons.
leptic Tank—Liquid capacity(_QQQ.gallons f.ength Width , Diameter Deptth_.__..__
)isposal Trench— No.....�....._... Width..... Total Length_6 a Total leaching area-S7 4 sq ft.
leepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
)ther Distribution box
'ercolation Test Results
Test Pit No. I
Test Pit No.
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
)escription of Soil
Sature of Repairs or Alterations—Answer when applicable
agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
he provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
peration until a Certificate of Compliance has beptt i
ed.
rt
.uea Dy tue
r
application Approved By -rz(°EZ-- _.1%
d of heajth.
I _ LJ
21/Ardpiid I%E[.
Date
application Disapproved for the following reasons'
Permit No
v Date
Issued Llz^4 31 /9/ ei
Date
y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
.�ertifirttte of To *mu
THIS IS `I / EP/ASY, 2jhat Ate In rvldual Sewage Disposal System constructed (or Repaired (
T�Q 11111
Eli
ih/ r -� ( Installer
Is been installed in accorda%ce frit/h the provisions of Article XI of The State Sanitary Code as described in the
pplication for Disposal Works Construction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
YSTEM WILL FUNCTION SATISFACTORY.
ATF °2 a, 1 7 J4 Inspector
;o 1 P 7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
6,Citt OF
Diu}mnttl Wnfrkn ([[unntrt rtiun rrmit
granted (1<.t: .:.._..1 4:��
Permission, i hereby gr
1 Construct iff) or gepair ( ) an Individual Sewage Disposal System
No 4.F.> e.!..: ?J.:(:s:t ':k/.....JLY.X -&-44.
FEE
Street / [ I�,
s shown on the application for Disposal Works Construction �Perm�it No_l.f._f..y'—/ _. Dated )/tl+�yl 34 ��G
_`"I_ n.....r ..i.h J
SATE
>RM 1255 HOSES & WARREN. INC.. PUBLISHERS
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF4EALTH
C�-�A.... OF �.IJOL
FEE
{{
Applirattunl fur Dispnsttl illurks Anstrurtinn hermit
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at: /
(I.sX. �I, . � qj z C V ( )4c
rr K7F� Aches,
� �1HZ_cc_ u -t17 i Lam"_ °` °
Add.ess
C
Type of Building L�♦ g. Size Lot j !i
Dwelling—No. of I3edroo s "'
'r Fxpa ion Attic ( ) Garbage Grinder
Other—T e of Buildin !
OP g No. of persons Showers ( ) Cafeteria ( )
Other fixtures
Design Flow 5 CJ gallons per person per day. Total daily flow.ryn--v L.Cf2C gallons.
Septic Tank—Liquid capacity/OCO gallons Length Width Diameter Depth
Disposal Trench— No. .._R�.__._... \Vidth Z Total Length_-.S_O Total leachi area.. Z.4.�
Seepage Pit No Diameter -+--sq. ft.
Depth below inlet_ Total leaching area sq. ft.
Other Distribution box ( ) Dosing'L�tk
Percolation Test Results Performed by_(�.i • yip-,� Date Z--Z '—ear_
Test Pit No. 1 minutes per inch Depth of Test Pit_. li(,SG �.Depth to ground water. .4%-A,,2,,_
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil ..Yom.
A . '
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
aperation until a Certificate of Compliance has//beee�pp issued by the board of health. f
Signed fifLA-7
f
Application Approved By
Application Disapproved for the following reasons
in accordance with
place the system in
Z - 18 "C.4
Date
Permit No Issued
Daft
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
a +
. OF
(Irrtifiratr of Complianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( )
by
,^ awctsE ti �
at .'.-a l,4f'=� ( C .0 n:raCo-r /1 State has been installed in accordance with the provisions of Article XI of The State Sanitary Code as deseribed n_the
ca
applition for Disposal Works Construction Permit No Spy dated ._;---.f c;'" G
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARWNTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE '" _ .. ' J j(� f Inspector - ��`�i1+} i� .LicA-F-4-eceT�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ;jot'_ /,
' Iasi_ rr7
No.._...._..Z FEE
Disposal Ninrks, onstrrurtion Iltrmit
Permission is hereby granted C �: e(/...cLSt .mJS.
to Construct 05 or Repair ( ) an Individual Sewage Dispbsal System
at No
seta
as shown on the application for Disposal Works Construction Permit No % Dated
DATF
FORM 1255 MOSES & WARREN. INC., PUBLISHERS
b tie 1
Boat of Health
D B87
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O X F yH�E—ALTH
OF 9
Applicatian for Uiapusul Marlin Znuustrurtiun lrrmit
Faa.J t 4°
Application is hereby made for a Permit to Construct (1 ) or Repair ( ) an Individual Sewage Disposal
'stmt at:
Ow
:taller
or Lot No.
Address
Address
ype 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
esign Flow gallons per person per day. Total daily flow gallons.
optic Tank—Liquid capacitJQ.e8gallons Length Width Diameter Depth
isposal Trench--No. Width Total Length_ __-_.Total leaching area (q.O.d...sq. ft.
eepage Pit No Diameter Depth below inlet Total leaching area sq. ft
ether Distribution box ( ) Dosing tank ( )
'ercolation 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
lescription of Soil
;attire of Repairs or Alterations—Answer when applicable
agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
ae provisions otTITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
peration until a Certificate of Compliance has been issued by the h and of sealth.
Signed — - tan---� kg 11(P� ..._._
Date J9111
\yplication Approved By . .. ._. ../K.�XL -.- �l�,fe
kpplication Disapproved for the following reasons'
Permit No. 817 Issued
Dat
1.6 19 n
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
kirrtifirtttr of flnmplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
tostaeer
at
has been installed in accordance with the provisions of Ti'.'': 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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Disposal Marko Otnnntrurfinn lrrmit
FEEL
Permission is-hereby granted
to Construct (_ ) or Repair ( ) an Individual Sewage Disposal System
at No
s«
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
rORM 1255 HOBBS & WARREN, INC., PUBLISHERS