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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