Applications & Permits •
N.
A
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�c 4_.._. _oF 7.10-irti k
Application for Illihpusttl Iih urku tnntfrnrtinn Ilan&
Application is hereby made for a Permit to Construct (lam) or Repair ( ) an Individual Sewage Disposal
System a/t,/t/j//
-1-^`<hiarwn es Address ft�—� ,{ 'Owner r3
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
V ..7Z.1..8"
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capacit(
Disposal Trench—No
Seepage Pit No
Other Distribution box ( )
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
_ gallons per person per day. Total daily flow gallons.
...gallons Length Width Diameter De th
Width Total Length Total leaching area Qa_.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 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 i ed y the board of health.
Application Approved By
Application Disapproved for the following reasons'
Da<e E .
mate
Permit No....
,��....��...�
Issued Z ...L97.�
Date
Daft
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
fl.ertifiratr of Uiamplianre
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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD , OF HEALTH
y v
u j eLf/r OF l.,i ..ntrR.1
laispns El ark(s"���f'�g�,attatrurtqiun rrmit
Permission is eby granted...L t,d.S! aB 4dah`- A'It
to shown on the or Repair ( ) Individual Sewage " posal SystMi
a I
at No ice..# �i,�..i Street
as . r/ .......r.
pp canon for Disposal Works Construction permit No..�fX % Datedx �.(
..4r -s.:d.•• a t.:I4t'...{
Board of Health/
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No ..57-5-e
System at:
THE COMMONWEALTH OF MASSACHUSETTS
� %
B- OARD OF HEALTH
Q#t}ttttttttnit far 113tS}tAffMl Rai nrh/g/Cnunntrttriinn P
rrmrt
Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal
at Lot Na.
Owner Installer of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
Septic Tank—Liquid capacit
Disposal Trench—No
Seepage Pit No Diam
Other Distribution box ( )
Percolation Test Results Perf
Test Pit No. 1 minu
Test Pit No. 2 mint
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
No. of persons
gallons per person per day. Total daily flow gallons.
ow Depth
-.-
d gallons Length Width Diameter V
Width Total Length Total leaching area k11L'—sq. ft.
eter Depth below inlet Total leaching area sq. ft.
Dosing tank ( ) Date
armed by Depth to ground water
tes per inch Depth of Test Pit Depth to ground water
es per inch Depth of Test Pit eP
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Agreement:
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 beerBissued by the board of
Application Approved By
Application Disapproved for the following reasons
fit_ ed91-2--
'J
Permit No -515-6
Date
Issued Lei 7 I97„Z
nab
by
at
has been installed in accordance with the provisions of Article XI of The State Sanitary dated Code as described in the
application for Disposal Works Construction Permit No
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
Qlrrtificatt of &nnptiantm
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ice Lirij
3�is}Tnsl r;nrks (nnstruttinn 3ermit
Permission i ereby granted �Q K-�k sta-f-'--`✓k'� 6'°
to Construct (Y ) r Repair ( ) a ndividual Sewage Disposal System
at No ..._.1... -- •;-?/ Street
as shown on the application for Disposal Works Construction Permit No-r` .v Dated. #.l
Ewa of Healte
FRE...�:_:.II...K....
DATE
FORM 1255 HOBB5 & WARREN. INC
PUBLISHERS
No 375IY
Fas_4137 e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
or c+nt'.t
Appliratinn far +�in}rnsttl �rnrk�(nnztrurtinn hermit
Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal
System at:
n ta[I
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures gallons.
Design Flow ((��l gallons per person per day. Total daily flow g
Septic Tank—Liquid capacit45-6 gallons Length Width Diameter De th
Disposal Trench-No. Width Total Length Total leaching area K4.a�._
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
025? e5:—.
or Lot No.
Address
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
Description of Soi
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
Application Disapproved for the following reasons-
Signed
itLit
Apt_ taiatteitz
Permit No 51-
Date
Issued tt__ 7,_.,al 7)—
Date
by
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
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
(rrtifitatr of (aumpliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
THE COMMONWEALTH OF MASSACHUSETTS
trrrr BOARD OF HEALTH
!lisps orho Tonstrnriion :twit
.catty ft .
Permission tuc ( "thereby) oRepair,( ndividalal sewage Disposal Sy
to Construct (V ) or Repair ( )
1 � ' r
at No -r-d. --...I %- Street '
as shown on the application for Disposal Works Construction Pdrmtt No :.-.'� Dated.d.2.C-F /Board of Heat*
DATE
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Lbi - r , OF ` it r
�J v
�pplirttiinu far Timu ttl e arkaa Tattnirurtinu Pauli
Application is hereby made for a Permit to Construct (lam) or Repair ( ) an Indic idual Sewage Disposal
Faa. ,..lJ.... T
(
System at:
zi e)4atr '-a'
y r -3 6
or Lot No.
Address
�,r/ �/ Owner K( kt'"49'u- r.“31/4i+^^ut Address
V
Type of Building Size Lot Sq. feet
e
Dwelling-No. of Bedrooms Expansion Attic ( ) Garba g Grinder (
Other—Type of Building
No. of persons Showers ( ) — Cafeteria ( )
Other fixtures - gallons.
Design Flow �� <� gallons per person per day. Total daily flow lle th
Septic Tank—Liquid capacit)1a gallons Length Width Diameter P
Disposal Trench—No. Width. Total Length Total leaching area S--.(1.11 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Date
Percolation Test Results inu es per by Depth to ground water
Test Pit No. 1 minutes per inch Depth of Test Pit De th to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit P g
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
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 on until a Certificate of Compliance .as.been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons'
Permit No.....55 --
Date
Issued " yd -
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qlrrtifkate of taumpHanre
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
No
d
Permission
to Construct (C.
at No .:�...
as shown on the
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 t-
`..f..t4�.._.....OF ,/)„,/,— ,tn'Nei J Fea
Disposal r B uriis ((Construction 'permit
is reby granted.......--..i ,.x >lrhxwk..�F2...c,,.(..).;q.
) or Repair ( ) an Individual Sewage Disposal System's
-^'d' Street
application for Disposal Works Construction Permit No. .i..at..--- Dated.{..:f.1d '
Board of Health
DATE
FORM 1255 HOBBS & WARRE_N. INC.. PUBLISHERS