380 Applications & Permits 170NNONWLAITII Oi MASSA[IIUS£ITS
Brand of RaWi AM 7V N7MI/fr. ,ILI
i_£RT1F CAT£ f) COMPII,ANCE
Description of Work: 0 Individual Componentts) )e Complete system
The d r i nrd hereby rlb that the Sr a Dis s.l Svrten: Cs nni red O-Repaired t4
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( :1 i'IDLY a>/ 4
no
FEE
dcdl )..Ahandoncd i t
been II d in a -pdancc:girl, the p ton of 310 CMR 15.00 �T.I 5 ) and the approved dertgn plan
app l - ]s f dated /r) - %-Y7 Approved De ig t Flow 5-'q igpd)
Installer —774 ;rOri rQarsv o�
Des:c:rr: T/W /f/ f//r// d F Inspertnr:
hrLiI plans rdacng to
ctr { - Das 2/-7;S7
The issuance of this permit shall not he construed as a guarantee that the system va function as designed.
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COMMONWIL1LTU OF ASSAC}IUS£TTS
Matti of Health ' f� <lL2t.;,i /441
DISPOSAL SYSTDI CO 1STRfI(,TION1 PERMIT
Perm sion ishcreb}.4lapred ttCons uct rirt,'7 .ttpgl atle( ) .Abandon( ) an indnidual sewage disposal system.
"/ f as described in the application for
Dip al System Consrructiun Pecmii No. E / dated
Provided: Consir c I Shall be completed within three)°ears of the date of this 1) 1 . sill to p1 con tans must be net.
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r:rn e e xm_su to eo:ec sic
Date Board of Health
kppliyad 0
COMMONWEALTH OP MASSACHUSETTS
Boma rrJHvalth HORTHAM'TO N . .t41.
APPLICATION Ft)
FEE
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Perini(to Qmstr uct( ) Repalr(16 LpgradrV Abandon( ) - ❑Complete System ifIndividual Componen
Luarrinn 3Sa CH r r
RD
=� �s-FI Okii
Owmr\Same. &CM IC
%I ii Pare I
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Address 3 CHES1ERAEL.D RD
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Telephone# (,) �3-- 7 9917
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1 talcr•sNamc //(g/cc.�6/r , /rclb...„ ,
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DesignervName-71M07� MA6)ilivIS Rs
A dress 3 7 //Yy l✓ / ,
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Address 7a In6k /R6u5 RD- YY HAel
telephone# tp} Jr ,(; :' il 3-
°
Telephone# (4/3 } s_27 - 52j1
Type of Building
.5/A/61-e fitnJLv
r7L
Dhvcllurg-No of hi—gloom)
Other-Tine of Bin:ding
Odic' townies
hut Size
No.of persons
S
sq.B
F. ' - y?
/n
Showers V),Cafeteria(
Deng-n Flow(min.regniTed) 474 gpd Cal (frog Design flow prodded 3-0ic gpd
Bow ititca
Plan: Dare /0-020 -q r7
Numbe of sheets
Recision Date
hilt- "'Drys ofp'Ro '03ED 5u85442 Ar
D:waption ofSoil()l/�/ 5
Foil Ftdii twr Fawn No. Name of Soil Eealnaior
S wAce DrSPa5M- L 'FPAl2
/i cT tL /f
tRm
oti- /✓(15S Date ofFyabmdnn /0-2-`
/n�61M/v7 �/- /o
DE.SCRIVTION OFREP.AIRSORAITERATIONS REVLAGg FAI L I Ai A, 5u/3SORFA( C Sblt/Am err-
D/5100 5A-C 5y5%
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further es..ttoyo not to pla a the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Xlgne dor AAA%) Dare /a - F- 97
Inspettions
THE COMMONWEALTH OF MASSACHUSETTS
C
BOARD OF HEALTH
/
OF _ . . ..
(E*tifiratr of (Enmp1iianrr
THIS ISO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (y.)
by ♦ µ,.1.1 A.__-L —ea....:S„ natitar re.. _.._.. ._._._
has been installed in accordance with the pr yisions of TITLE 5 of The State Sanitary Code s de ribed in the
application for Disposal Works Construction Permit No.... .1 )t dated..... j'X 41. _.�_>..._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RA THAT THE
SYSTEM WILL-FUNCTION SATISFACTORY.
DATE.. M.I:= .0=.._111.}„ Inspector .,.6J:.-r:- 1
•
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
C.e' k OFD L{.N.
1
ilispnEal,. urks,(1Inns#rurii� ]rrmif
Permission is hereby granted_._/e-4-1 :4....0 4.e��y 2 4- -
at No
to Construct ( 1w or R�tr ) ani Indivi Sri/age id" System
as shown on the application for Disposal W rks Construction Permit biro.y_:)rI D r.r./-) 1?
.r 1� + 411‘. nL b-- .....
aM Health
Fax a'
DATE !/4$i1.}' 1-f9 )1
FOPM 1255 A. M. SULK171. INC
I-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H LTH /
.Appliratiunrfur QI5puna1 fEarks Otthiutrut#inn yrrmu
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
at.w Addr.ae • ._ ._
rla Nu
Address
N t�
Fsi roc
mtoamner J � 1 Address 'T
V Type of Building t Size Lot _ Sq. feet
Dwelling—No. of Bedrooms.._ a
J _._....._.._._.Expansiov Attic ( ) Garbage Grinder ( )
aOther—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Q Other fixtures
cal Design Flow gallons per person per day. Total daily flow _..._._._.._ gallons.
C4 Septic Tank—Liquid capacity./SS.CrSallons Length Width.. Diameter Depth
x• Disposal Trench—No. Width.._.. Total Length Total leaching area sq. ft.
3 Seepage Pit No Diameter Depth below inlet..........._.._..Total leaching arm sq. ft.
z Other Distribution box ( ) Dosing tank ( )
.J Percolation Test Results Performed by Date .
_.t Test Pit No. I minutes per inch Depth of Test P: Depth to ground water
R. Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
ce
O Description of Soil - Y�
5
Li ped/Natureppf Repaf�rrs or terations Answer whep appl' ale.. ?::
Agreement: Li
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.
QtSeti... ...e..—, . -
tit " t
Application Approved By .. :774— (_ `--�+
Application Disapproved for the following reasons
pa ti:G.. T
1—_
Permit No.
Date