388 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Gtr C_.. OF N oKT&ill,' Pro et-/
Fax
Application for Motional Marks gonotrnrtion Vaunt
Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal
tern at:
• 'f> Sal Ui°STE/Z Rdr Ctrl%
Location•Address
'Tr,A'fiermAJ Lill twq55c
Owner
t,�smier
pc of Building
Dwelling--No. of Bedrooms
Other—Type of Building
Other fixtures
/9eie P194/
or Lot No.
/v97 P,sic
Address
Address
Size Lot.L%'4.y0.04..Sq. feet
3 Expansion Attic ( ) Garbage Grinder (( 1
No. of persons Showers ( ) — Cafeteria ( )
!sign Flow s O gallons per person per
:ptic Tank—Liquid capacityZ5Pgallons Length
sposal Trench—No. Width_&Q Total L
srpage Pit No Diameter Depth Belo
[her Distribution box (X) Dosing tank ( )
ercolation Test Results Performed by lAst?‘D.., .e&
Test Pit No. 1 7 minutes per inch Depth of Test Pit.. J(e
Test Pit No. 2 minutes per inch Depth of Test Pit &.f
day. Total daily flow c3 0o gallons.
Width Diameter Depth
ength .7-‘1 "-- Total leaching area 9+ra sq. ft.
w inlet Total leaching area sq. ft.
/2/7 Date...Co —
Depth to grog' '.,•'"�. �4 r
Depth to
�rxwR.E -F. _r . aze� ;. c1
cscri tion of Soil ra
iLLy 6L.&227— OF GL91C
:attire of Repairs or Alterations—Answer when applicable
agreement:
The undersigned agrees to install the aforedescribed individual Sewage Disposal System
Ile provieious of Article XI of the State Sanitary Code— The undersigned further agrees not to
iperation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons'
in accordance with
place the system in
— io-7/
Permit No
Issued
Date
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(IIertifirate of alompiianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
1 =C 1 installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
split- n for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
YSTEM WILL FUNCTION SATISFACTORY.
OAT F Inspector
do
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF . . .
Motional
�rc
arks Qlonotrnrtion 3rrmit
FEE
Perms::ion is hereby granted
o (:unxruct ( ) or Repair ( ) an Individual Sewage Disposal System
it No Strrot
I. :dicta n on the application for Disposal Works Construction Permit No _
Dated
VP
p.�. 1255 eoa is a WPRREN. INC_ v..a—ISHZas
of io-ram
THE COMMONWEALTH OF MASSACHUSETTS
FES
BOARD OF HEALTH
r_ ITr OF NoaTHaMPTo/✓
4pplira/inn fur Thtipnnnl Tlurku Tonutrnrtiun ' lrrmit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
tem at:
r?S's S r I id ES Teec b!. GIr1� fEfi PL.n
rI tNa.
cn<xan-t2t? S _ K in-t X_l9TFd 5i 0
.T.€P_.rt<.N F, V.liNl? Ste. Address
Owner
m.cai.r Address /80 Q o O Sq. feet
Size Lot h 4
pc of Building Garbage Grinder (�
Expansion Attic ( )
Otheri—Type of Bedrooms `� No. of persons Showers ( ) -- Cafeteria ( )
Other—Type of Building
Other fixtures O O gallons
:sign Flow CO gallons per person per day. Total daily flow Depth
sposal l Tr nc Liquid capacity j�$Ogaltons Length
Width Diameter
Width 2a - Total Length f z — Total leaching aver 9,j"O
silage Pit No Total leaching area sq. ft.
�epage Pit No Diameter Depth below inlet g
titer Distribution box (YO Dosing tank ( ) _ _
ercolation Test Results Performed by kV' OF. _ot/ND
Test Pit No. 1 7 minutes per inch Depth of Test Pit LTA. Depth to gratin•,-• - +off _d1
Test Pit No. 2 minutes per inch Depth of Test Pit a Depth to gr• l .- -
esaiptmn of Soil
L48r..+i — /VI 1.1..2ld.!t O P a..f_N.
S r.EAT" ¢.F G1rg.r
nturc of Repairs or Alterations—Answer when applicable
agreement:
The undersigned agrees to install the aforedescribed individual Sewage Disposal System
he provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to
Iperation until a Certificate of Compliance has been issued by the board of health.
Signed_ 9e<L-.07(astt •-R:.x_.
Application Approved By
Application Disapproved for the following reasons
in accordance with
place the system in
fa —/e2 it
Issued
Permit No
Date
Date
Date
Date
Jy
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
fdertifiratr of (gunman=
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at..
As. 1; installed in accordance with the provisions of _Article XI of The State Sanitary Code as described in the
ipplic 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
13ioflooa! rr;orho Trinatrurtion ljermit
FEE
Perini.=ion is hereby granted
to Construct l ) or Repair ( ) an Individual Sewage Disposal System
It No . . ..
snat
sinm n on the application for Disposal Works Construction Permit No Dated
1255 RC/CPI: a WAdafN. INC. rCISL5HEn
n.,m or urnam