Applications & Permits qa.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G/Ty OF A'C7i�r 1%nPtcA
Fits
Application for Disposal iii.orlts Qtonstrnrtion Permit
Application is hereby made for a Permit to Construct (4') or Repair ( ) an Individual Sewage Disposal
System at:
Location•Address
Tc?�__ac�yt 1L7
owner
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow S 0 gallons per person per day. Total daily flow '3.Q. gallons.
Septic Tank 8yguid capacityd`C'fc..gallons Length.st-4..... Width S-¢`r Diameter Depth../- -1Q r
Disposal T.enrii—No. L Width...A.0 Total Length 3c Total leaching area...Caa.0.....sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank i ) // /
Percolation Test Results Performed by.2 f{ti:T'." T4-
.I7'W. e7 44;./4 :k: Date C' /`a 7 3
Test Pit No. 1 4' minutes per inch Depth of Test Pit..3 —3".
3•s Depth to ground water A/c 4/C
Test Pit No. 2 -"" minutes per inch Depth of Test Pit...' 0" Depth to ground water._. '--C'd
3
/-:?:,a..g/ 221.
It 4 7
ot No
Address
Address
Size Lott r> Q.4 Y Sq. feet
Expansion Attic ( ) Garbage Grinder (
No. of persons Showers ( ) — Cafeteria ( )
Description of Soil ' 4 T V'Jt' r.1'-p'• -S/4-7-. 4./ct p CL-4 0 -C
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Application Approved By
Signed
Application Disapproved for the following reasons•
Permit No Issued
Date
Date
Date
Date
Jo
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/
C/ 7/ OF 7teniA 2,'f'7 c�
into Qtnnstrurtinn lJnmit
Application for Disposal
Application is hereby made for a Permit to
iyste n:
1 �� //�Aer-
Fria
Construct ( ') or Repair ( ) an Individual Sewage Disposal
Location-Address
?c:7D Zein.ebd.t`rt7
Owner
Installer
rype of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons
Other fixtures
3 e;Ci lons.
Design Flow =.t-� gallons per persons�e*� day. Total daily flow 6+1
Septic Ta��—�a-Laiquid capacity19Qlgallons Length (Y "6G clay.
—i.'Diameter Depth..4..:-tC.`.
Disposal 'W. —No..._...1........._. Width a-c Total Length 30 Total leaching area_Czez 0 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Dther Distribution box ( ) Dosing tank ) -
y,J / J/ y .AirseDate.... /02 /73
Percolation Test Results Performed b ..:_l.`..!�....Z._^-...fYS!..v'ZG.iR.-- d'
Test Pit No. 1 7 minutes per inch Depth of Test Pit..3 -- 3 Depth to groan water._rtde We-
Test Pit No. 2 — minutes per inch Depth of Test Pit 4 Q... Depth to ground water 5-r_ C
3
or tut No.
Address
Address
Size LotJ4?1 1 - Sq. feet
Expansion Attic ( ) Garbage Grinder (�
Showers ( ) — Cafeteria ( )
Description of Soil.! t 4+" • c • 3?e y L tf(/ 3 0.
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Application Approved By
Signed.
Application Disapproved for the following reasons.
Date
Date
Date
Permit No — Issued.
Date
0.
PHE COMMONWEALTH OF MASSACHUSETTS
-14- 2-S&,
Fes
BOARD OF HEALTH
0/
TY Or /4/0te/bin/A'7O-4/
Application for illispnnaI WnrIu Lon itrurtinn Jrrmit
Application is hereby made for a Permit to Loh-,truct t s",(or Repair t t an Individual Sewage Disposal
listens at:
TE K//L( x4
4fils S
Owner
tn, 1]]er
type of Building
Dwelling— No. of Bedrooms
Other—Type of Building
Other fixtures ...
Design Flow • .S) galb_ s
Septic Ta` ,�r quid capaa .[ lPQOgallo sM
Disposal 'Fa'6drh- N'o ) _ Width
Seepage Pit Na__ -__ . Dian-.ctor.
Dther Distribution box it
Percolation Test Results Performed b
Test Pit No. I 7 minutes per inch
Test Pit No. v minutes per Imh
3
Sipe I.ot%r��1'./'Q Sq. feet
Attic ll:r. rgr Grinder (Itter
Showers t Cafeteria ( )
{c 1 lot 1 f '•v i9__ Mons.
.dtl .S i..n car urpth-T
n.. . • agih. 3 P _ l :al i'g .irta 60 Q_ sq. ft.
I bias leachi:rg :.rra. __ -.—sq. ft.
,t, t .,�/a
/-}s!.✓.TC E.01�.ptl, to gte WC ..
,..1, t . . Pi; 3 ' a Depd. to t- ,n.t'w:aer "1/0,
Pit 6 4_I.. Depth to ground water .S -0
Description of Soil./ - 4 7u.[.°.QQ" ;Si
Nature of Repairs or Alterations—Answer when ;tool•c.Sle
Agreement:
The undersigned .greet to install the aioredr
the provisions of Article :SI d the Starr ' a T t "
operation until a Certihrate of C ontpliance has boo,
Signed_
Application Approved B,. .. _. .
Application Discpproved for the ;ollounng reason.
s/e 7 f
ecd/ 3 0.'
Iv:dua
Svste
Ce not u
ce with
item in
h
Permit No
Issued_.___ _.
u:.
THE COMMCNWEN.TH C)F MA SSACHU5ETT5
BOARD OF HEALTH
(EOF 72t7*1- w
rrtifiratr of Co pliancy
s «.u( � r., :tir�a ( >
7111,- IO ' f.11y!:4 f'. the L: i ,: I i, .i
�5b Cc f
� 1 knit r ( o ti 1 u. 1 the
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A
'I 1 5 A GUARANTEE THAT THE
■YSTEM WILL FUNCTION SATISFACTORY.
`�_ e,{
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CS 7/ of /VC rPT/fArrrO oh/
P}Ipliratian fur Qis#Insal
arks (Qanstrurtinn hermit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
;yard=at:
IcCatioa.Add=s
Owner
Installer
or Lot No
Address
t'ype of Building
Dwelling—No. of Bedrooms 3 Expansion A
Other—Type of Building No. of persons
Other fixtures
)esign Flow `lam gallons per person per day. Total daily flow a ace gallons.
'Septic Ta�iquid capacityiCQQ..gallons Length."'6 '' Width.5"—Q.`Diameter Depth..? —eC '
)isposal No./ Width 2C Total Length S O Total leaching area 4,Oa.....sq. ft.
'Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
hher Distribution box ( ) Dosing tank ( )
?ercolation Test Results Performed by. i %%r. T a- c'{,(.7e cY 42/6j..Date 6A/7-3
Test Pit No. I / minutes per inch Depth of Test Pit 3' 7". Depth to ground water...4/4/ /
Test Pit No. 2 minutes per inch Depth of Test Pit.? a " Depth to ground water...1 -R "
Address
Size Lot..L 6 0 -rSq. feet
c ( ) Garbage Grinder
Showers ( ) — Cafeteria ( )
)ascription of Soil1 = R �L'.f..'Sc'.Li:.r -3 A" .FL.T• C G AV 3=-G
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 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
Application Disapproved for the following reasons-
Date
Date
Date
Permit No Issued.
n e
qa...._....._.._. Fns..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH /
Ci Ty OF.. N ze.Z>9zfi F'1en(
Application for Disposal
is
arks alonstrixction Permit
Application is hereby made for a Permit to Construct (4or Repair ( ) an Individual Sewage Disposal
System at:
•Address
Owner Address
//
or Lot No.
Installer Address
Size Lot./4_3.0-0 t-Sq. feet
Expansion Attic ( ) Garbage Grinder (L)'
Showers ( ) — Cafeteria ( )
rype of Building
Dwelling—No. of Bedrooms 3
Other—Type of Building No. of persons
Other fixtures
Design Flow ire gallons per person per day. Total daily flow '3`��' gallons.
5
Septic T —Ligmd rapacity/C.G.C.gallons Length G._�Width S `¢� Diameter Depth.. (e
Disposal�—No. / Width "Z c' Total Length 3c, Total leaching area_..G0l0..sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching arm sq. ft.
Dther Distribution box ( ) Dosing to ( ) ,,//
Percolation Test Results Performed by,/ rfr.7"r A#1t -�'y L�1VG.4.7, Date..��itt.73
Test Pit No. 1../ Ca .minutes per inch Depth of Test Pit-3r 3.. Depth to ground water..l. QA.LC
Test Pit No. 2...._..........minutes per inch Depth of Test Pit Depth to ground water
Description of Soil---I`e O.e,{s/i.Ult,.....Z«Q,y:/O " 57t&'... .SLi.I;..._2''c ' 7'"4/6-- -Y/frill)
O L:. 'tr../ < .✓c— .,Fri
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 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
Application Disapproved for the following reasons•
Date
Date
Date
Permit No Issued
Date
10
En
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C rY OF lf "e7f1f?gill' ro�
.P ppliratinn for Disposal FE arks Gans#ruction hermit
Application is hereby made for a Permit to Construct (41 or Repair ( ) an Individual Sewage Disposal
l4.ac tion Address or Lot No
ren rte =r27 Address
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons
Other fixtures
Design Flow If'L gallons per person r day. Total daily flow o c gallons.
Septic Ta —Liquid capacity/L CC.gallons Lengths 4'rr Width. "-c:.%' Diameter Depth._ir...-'/Q.`
Disposal �— No ! Width c 9 Total Length a ° Total leaching area-_. c' sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dostngt�l ) G- isa 7>
Percolation Test Results Performed by J.fgi&:71 i.V74 e) 2-i1/G,. • Date _
Test Pit No. 1 2/ minutes per inch Depth of Test Pit 3 '/ " Depth to ground water diode"
Test Pit No. 2 — minutes per inch Depth of Test Pit O" Depth to ground water...dailC-
Address /at) _
Size ze Lot./ot. .F T S4. feet
Expansion Attic ( ) Garbage Grinder (✓°)
Showers ( ) — Cafeteria ( )
t7e/
Description of Soil 3
O.e.ddeQ/'C 7Qz&S.e/ -5 4-4/oy Si c 7 - Y t - 31--P
5/94/, " f -
I Ay
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 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
Application Disapproved for the following reosons•
Permit No
Issued-
Date
Date
Date
Date
lo
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4 4,7A/ 7/A? 7-ct./
(—r r/ OF
pliratinn for Disposal r'irks Wonstrurtinn l9ermit
Application is hereby made for a Permit to Construct (1--1 or Repair ( ) an Individual Sewage Disposal
iy at:
7
aon•Address
Address
type of Building
owner
/3
or Lot No.
Address
Natalia - Size Lott:$ecQ -r- Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (‘'-1-.
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures 3 c, gallons
Design Flow SO gallons per person day. Total daily flow
Septic T — iquid capacitySS49gallons Length "/c" Width 5'te Diameter
Disposal No. / Width ' Total Length - `'' Total leaching area...4t.aC...sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( ) (//-V73
Percolation Tut Results Performed byJ...tie/CT - NiTL ExZ-4/6...ct?-._ Data Node--
Test Pit No. 1./ 4P minutes per inch Depth of Test Pit 3 o . Depth to ground water
Test Pit No. 2 — .minutes per inch Depth of Test Pit..6'-C' " Depth to ground water -1/a h
Description of Soil 6,r ePG_ f& ..C. 7/JPS0 /e-' /=rr ✓,4- -may' i'c"/een rc4/r
SA4iP E` cz-,11
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 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
Application Disapproved for the following reasons•
Permit No Issued.
Date
Date
Date
Date
la
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C 7y 44
OF !.ezib9''f'/i>c:w,s
Application for Disposal a nrkn ltlunstrurtinn Permit
Application is hereby made for a Permit to Construct (1," Or Repair ( ) an Individual Sewage Disposal
system at:
itt /ye-
yy�eeeaation Address or Lot No.
aci.“'.l ZsT
owner
Address
Installer Address /� >
ori-
fype of Building Size Lot f.0 Sq. feet
Dwelling—No. of Bedrooms ' Expansion Attic ( ) Garbage Grinder (L
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow re gallons per person day. Total daily,flow "3c OD lone.
Septic T Liquid capacity) .C.Cgallons Length 4 n Width �'t Diameter Depth�/o n
Disposal e r—No. / Width ;O Total Length s•• Total leaching area_.‘iil O sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Dther Distribution box ( ) Dosing,tank ( ) �) 9
Percolation Test Results Performed by ✓f/'f4'' / C 1'TFy. tA/G 2' Date / 3
Test Pit No. 122- <P minutes per inch Depth of Test Pit .j _Cc 4 Depth to ground water A/0•i/r'
Test Pit No. 2...— .minutes per inch Depth of Test Pit...((a.--I1 ' Depth to ground water '—/u ej
Description of Soil ZcaaC..c- 7'y a Ls .Y f• r c/ 3tti/1 I s/c r re—c; re
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signet
Application Approved By /
Application Disapproved for the following reasons•
Permit No Issued.
Date
Date
Date
Date
Fag
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G 7_Y---- --OF /yo2.z/71AmP"7va/
Application for Disposal e I nrks Olunstrurtinn jgrrmit
Application is hereby made for a Permit to Construct ( `1----or Repair ( ) an Individual Sewage Disposal
iyst n/-ant: // nn
7 Location..Aadres.
c` 3
Owner Address
Installer
ype of Building Size Lot /"'�,4 "off t. Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder ('-')--
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
)esign Flow 56 gallons per person per day. Total daily flow 1 c_G gallons.
ieptic Tank—Liquid capacityl.Q.C.C_gallons Length..8.=.k.:'. Width S- 2:1.: Diameter Depth...11...::cc."
)isposal *ela—No. / Width a-o Total Length 3_a Total leaching area rat't'y sq. ft.
ieepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
fiber Distribution box ( ) Dori tank ( )
eel �1��C'T T-
'ercolation Test Results Performed by �z/ve:T..e..a7. et/.4a.zC Data 6.7-t1/7-;
Test Pit No. I S minutes per inch Depth of Test Pit -? ' • Depth to ground water'r/°.r.-
Test Pit No. 2...._-....._minutes per inch Depth of Test Pit //-G..:.. Depth to ground water....! 0
)ascription of Soil./ -p ` 4rZr'14�• 't,:
:surf 4 Zed< (` (Mc 6
Aa tZ
a" Ct
s y i%ti-c ✓o
Qature of Repairs or Alterations—Answer when applicable
kgreement:
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
rperation until a Certificate of Compliance has been issued by the board of health.
Signed.
kpplkation Approved By
Date
Date
Spplication Disapproved for the following reasons•
Date
Permit No Issued.
Date