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757 Septic Applications Permits & Compliance ),-449,7---o 4 4-g /ifit/4 rt--- .� 1 / a_/ - / _ / H i \ _ . ' -n- I \I I/' 1 c---O C ) t i' � nl C1 a,.�as C La- I 1 : 'fr 0/27± ( GEC CHECK OR FILL IN WHERE APPLICABLE C _ SL No �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF .Y Application for Disposal 'nitwits Qlunstrurtiun hermit Application is hereby nyyde for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - Location.Address Owner Installer 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 capacity gallons 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. 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 TITLE 5 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 Data Date Application Disapproved for the following reasons- Permit No Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / . OF (� (rthfirstr of Olumpltmut THIS IS/ f c$ II79 T the Individual Sewage Disposal System constructed ( ) or Repaired (s- by at 7-s"7 . .._l lC'� has been installed in accordance with the provisions of TITLS 5 of The State Sanitary Code desyribed in the application for Disposal Works Construction Permit No "a dated 7/2(. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEETHAT THE SYSTEM WILL F N({ CTA,ON SATISFACTORY. // DATE �1 stall Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 OF flispnthitt-Work Permission is hereby granted �lt� to Construct j1...or4epair lE-j '2n Individual Sewakcfiisprel at No �� 1 11 rrrmit i FEE / �`^ m as shown on the application for Disposal Works Construction Permit No } /7Dateck l Board DATE FORM 1255 P. M. r SULKIN. INC.. BOSTON CHECK OR FILL IN WHERE APPLICABLE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEATLTH OF / Application for Disposal arks Ctnnstructinn Frrmit Cc Ps._ a_...._. Application is hereby/+ de for a Permit to Construct ( ) or Repair (jO an Individual Sewage Disposal System at: 4^IR-I.IN`^�-1 ZC..._...._ -..__----------------._----'-r-Lot or test N No.o. Address Installer 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 capacity gallons 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. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date Test Pit No. I 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 y11. C?:..Cc 1t 4 t F.2-oz---t-e- Description of Soil Nature of epairsa Alt eyAtions— Agreement: ��d•�c..Jl The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 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. h2 app cabllie C � Application Approved By D Application Disapproved for the following seasons' Permit No Issued.. k THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cti OF Nor+)tamp ttn APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT vplwation lore Pe Him 1.0 Cnn.vucl I I Ral'air [/t'P,•eW. I Ak ndun I } 1( InplaIL Scste didJuul Cmlpnnanls .757 Florence- Read Bak 76 P45� C 7S DAso ns Ke.(k55 ICI Florence. Rd hlor+l. witrlen MA- OIOGO 413-585 -45B1 Hill4own Envinnmt.hI Cansal4'm9 P,o 'Box 2Z4 N, 44a4tetd MA 01066 413-247- WA- Ii pc of Building: cage Family dune- Dwelling - -No.of Bedrooms other—Type of Building Other Pictures 4 Lot Size Sq. feet Garbage Grinder (tic) No.of persons Showers ( ). Cafeteria ( ) Design Flow (min. required) 440 gpd Calculated design floe gpd Design flow provided 453 gpd Platt: Date May 9 1997 Number of sheets j Revision Dale Title Sewele. b seosal SyS4Rkv. R-.parr Description of Soil(s) See- ' t!t.l Ewl. Form Soil Evaluator Form No. Name of Soil L'vuluaIor MaCklbm su^ Date of Evaluation 4 '6-JY DESCRIPTION OF REPAIRS OR ALTFRAI IONS RcpI4a .5.A.S, i Vpy-ade Pevmn ckinkr The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 an4iudf1er agrees not to place s stem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Inspectio Date FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE CORM/MONWE*LTH OF MASSACHUSETTS FIII, 48/1Y'{/e/t i%, '#"BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: .7 Individual Component(s) ❑Complete System The a td rsig ed herehM ccrtitw that the S etvage Disposal System'.Construcied( ).Repaired( )-Upgraded( ).Abandoned[ 1 by / fl I t / t ! %C at 71) / Y // .._.7-1 !l-,! has been installed in accordance with the provisions of 310 CM It I�i�r00 (Title 5) and the approved design plans/as-built plans relating to application No. /1�`a J dated ��3T"/ . Approved Design Flow 4/C 3 (gpd) —f / n a Installer //J. ( fr it-cc,- ff /4 4 . .. Designer: Alt('-1, u s T'h I /ylth4ctor 1 6. / -c 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 ,/ / No. — THE COMMONWE ALTH OF MASSACHUSETTS /f�Q ) al,LNi'/// <"BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herehy granted to Cori truct ( ) Repair f ''7pgrade ( ) Abandon ( ) an individual sewage disposal system at - //5 % IG/1 ,x '-e- .`6-4 as described 9"))))( F j_ in the application for Disposal System Construction Permit No. /� .dated > -/ Provided: Construction shall he completed within three years of the date of this penyit. 4TInc)copditioi u$be met. Date 4fi/ t7 -) I /: G7` L`j "2" (//7.‘,)2t Board of Health r1/� /�� .-_—^- FORM 2 - DSCP ! DEP APPROVED FORM 5/96 FORM 1255 LREV 5/96, N 1 Hovers a WAOReN m PUBLISHERS BOSTON