Lot 10 Septic Appications CHECK OR FILL IN WHERE APPLICABLE
No.—o Y-67.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD /,O F_ HEALTH
L.I_ OF tier-/— .YLd'% EJL
Appliratinn for ilopnnaf World Cnnustrurtinn Wroth
Application is hereby made for a Permit to Construct (Vr or Repair ( ) an Individual Sewage Disposal
System at:
110
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 gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacitl(e_gallons Length Width Diameter. Depth
Disposal Trench—No. / Width aLl t Total Length_ (!' Total leaching area./.C!.d_t 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 TIT:._, 5 of the State Sanitary Code 'he undersign- further agrees not to place the system in
operation until a Certificate of Compliance has been is � t e b.- r of health.
Sieacd
Application Approved By ./G_lfaZtntrty/
Application Disapproved for the following reasons' U
Date
Permit No 251
Issued
Dam
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qlrrtifiratr of CInmplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by
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
CHECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CI.l 1 OF F(OCE pAhtrrOAl
Applirnfinn far Blain-mat Inrltn (!Inttnfrnrfinn Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
&J1T5 9I i RQ4Q 10. /0
or Lot No.
hj CEO.?faE. 43.enh TO
Dt.ne. Aaaress
Lnsmller Address of Building .3 Size Lot I I)550 Sq. feet
Dwelling—No. of Bedrooms 9c- Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building CAPE No. of persons 0 Showers ( ) -- Cafeteria ( )
Other fixtures
Design Flow 50 gallons per person per day. Total daily flow 40° gallons.
Septic Tank—Liquid capacity ROObgallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total ]caching area 40° sq. ft.
Seepage Pit No Diameter Depth b ow inlets` F n fora leachin T area__. q. ft.-Other Distribution box (� Dosing tank ( 1.tAt,a.'Gl2.1.S. j ., s_ ,.ti a.n.-e-.-+
Percolation Test Results Performed by E. AFUE`�y Howl'Ley ( Date 14 it 6t 197/
Test Pit No. 1..3 5..Q minutes per inch Depth of Test Pit .Z I-00 1� Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil 4" Qf,AIUIC MATtth,_-f gl. CAA LOA1j IT-Cs" t.tEO. 5&jW,tl
SAtio
Nature of Repairs or Alterations—Answer when applicable
Agreement: NY a
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 issued by the board of health.
Signed
Date
Date
Dale
Application Approved By
Application Disapproved for the following reasons•
Permit No
Issued
Dale
III
Fn cdn,r.�
U Type of Building Size Lot 113'2,50 Sq. feet
Dwelling—No. of Bedrooms el" Expansion Attic
J CR E. n ( ) Garbage of feria (( )
G Other—Type of Building - k No. of persons g Showers
6 Other fixtures ( ) — Cafeteria ( )
Gd Desi▪gn Flow 50 gallons per person per elan. Total daily flow 4UU gallons
U Septic Pad:--Liquid capacity lCtc gallons Length Width I liametcr Depth
Disposal Trench - No. Width _Total I ength Total leaching area 4GO sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area nI. ft.
• Other Distribntinn box (✓) Dosing tank ( )
Percolation Test Results Performed by F. Fi Et'fr Date.l4PTtL ox 1971
.] Test Pit No. I...3, 0 Ininnies per inch Depth of Test i'it -1 1-�,• Depth to ground water
Test Pit No. 2 minutes per inch Depth of 'lest Pit Depth to ground water
4'
O Description of Soil 4" c". ' -ixiic i 4TfC
rZ t c3° saxto7 t CAP' iI-Et° lea geow..l saxtu
tet
u
u
V
No
FRE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Car/ OF over
Applirntinn for IJiopuisnl %i1LTri i (Cnxf 1tr11riiatt Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
13(1er5 PT 2642 ,{/o. /O -
1'1K CGFLdf' E t3a.("
Nature of Repairs or Alterations—Answer when applicable
Agreement: expo _u 1
The undersigned agrees to install the afored escribed individual Sewage Disposal S stem in accordance with
the provisions of Article NI ef the State Sanitary Code-- The under i,goal 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 reason.v-
Dam
Date
Elate
Permit No Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(!irrtitirnte of (tlrnuplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
at
has been installed in accordance with the provision. of Article AI of The Stale Sanitary Code as described in the
application for Ili-pnml Works Constructi,nl Permit No dated
THE ISSUANCE OF THIS CERTIFECATfi SHALL NOT DE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACuORY.
DATE
CHECK OR FILL IN WHERE APPLICABLE
No.. .�../
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FEE
et.t OF
Appiiratinn for Disposal rr into hlnnotrurtion 1 rrmit
Application is hereby made for a Permit to Construe
System at:
L
4Y(
tatalCadiri
Installer
(Y )
or Repair ( ) an Indic idual Sewage Disposal
/ 6
or Lot No.
Address
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
Design Flow
Septic Tank—Liquid
Disposal Trench No
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
gallons per person per day. Total daily flow gallons.
capamt))BS/ gallons Length Width Diameter Depth
_. .
Width Total Length Total leaching area....-c 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 aforedeseribed 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; issued by re h a f h r. -�-
..._.._ _ ; rt7 971
Application Approved By ,
� - - - .` date
Application Disapproved for the following reasons'
Permit No./. 77
Issued.
s I.T. )
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
llCrrtifiratr of Tomplinnrr
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