15 Applications & Permits No. �5'SS
THE/COMMON/ ACTH O MASSACHUSETTS
{ g �. MASSACHUSETTS
cApplictttion for !isposttl ' gotem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at:
I rcnbn Address or Lei No
AS h1/a &tea/�
Ovens Name Address and Tel N
be-e7/ / (t., iiStrke-t
Installers Name.Address,mid and Tn No.
Designers Narm Address and lei No
Type of Building:
Dwelling No.of Bedrooms
Other Type of Building
Other Fixtures
Design Flow
Plan Date
Title
Description of Soil
Garbage Grinder(
NE per Persons
Showers( ) Cafeteria
gallons per day. Calculated daily flow
Number of sheets
Revision Doe
gallons
Nature of Repairs or Alterations(Answer when applicable
/ fI f /34
r HG x 5�-
Date last inspected'
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and riot o place the system in operation until a
Certificate of Compliance ha been issued by this Board of Health.
Mign d y
Application Approved by f . e er O►�
Application Disapproved for the folio wi 4011Plerason s
Date 6-7/74s'
Dile_cS/i7/j S'
Permit No.
/S-SS
Date Issued
S-Iii/55^
THE COMMONWEALTH OFMASSACHUSETTS
,/ / )COMMONWEALTH
•�_ stir"n
MASSACHUSETTS
Certificate of Compliance
TIT/S Tf CERTIFT t the or�) F Sege Disposal System install/4c Tf o repaired/replaced(^)on
at
C") 035; l L., / a/ f r / 1
(Hsibeenconstructed in
d fly 1t h/rot p p p of Title hi and the for Disposal System Construction Permit No / dated
a z < . r/c 1 rr13 gfth €) t 4 cofdtto d f . C � pfov
co pl Ih t c set forth tlhbclo
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.This
Certificate expires on), CL/7 / r l I '/_ CJ -1-{:../ n I
/�'t '
DATE j .<--
•
THECOMMONWEA}ATTH OF MASSACHUSETTS ✓ f ' c �
/ >5 b.-/l; /by 1L""
MASSACHUSETTS FEE
!ispasnt e gstent Construction Permit
yr lull 1 .
Permission is hereby g(a/lted to t /
toe 7trlJc(( )or repair(1 I an On-se Sewage System located at /'J -
and as described in the above Application for Disposal System Construction Permit_The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special condition'.
All construction must be pl ted within Iwo years of the date below. ' ,^
DATE / I, / _p ( ' AL./' ----
Appro ed by
me.ins rte.Imam summit?.- asox ua
THE COM ONWEALT OF MASSACHUSETTS
iL' Tp_CERnr
�` by
ince with the
that the
M ASSAC H US Errs
gertifirttte of comp!innce
itc Sewage Disposal Sy�st�m--"installed ( )or repaired/replaced (X)on
cwsor Le y ;
�Ir
rovisions of Title
Ins been constructed in
5 nd the for Disposal System Construction Permit No /5 9 S dated
se of this system is con441ioped on compliance' it the provisions set Furth below:
e �IAP ..c 1' / r f (.Jt-d-YOU4d [12 %14I Ca
ie issuance
ate expires on
thi
ertifcate shall not''e c
strued
:et / ea
as a gr grantee that the system will tunetio
/7 /99S
Inspector
as designed. TI
Jv(
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C/Ty of /doer*944 -t/
Applirutinu far 1ispnsttl Harks QInnstrurttnn Permit
Application is hereby made for a Permit to Construct ( ) or Repair ()c) an Individual Sewage Disposal
System at: p.t //
WE9T,f/.4 y cTa.r/ 'ed M1/ 1G
Location-Address 15 E
/ 3 rrg.eq ,°,n�Ge
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow
or Lot No.
Lac Y>
We3TtYenP> es
l2D /i/T.f%
Address
Size Lot �S .LS ....Sq. feet
3 Expansion Attic ( ) Garbage Grinder ( ')
No. of persons Showers ( ))r— Cafeteria ( )
.�..5 gallons per person2er day. Total m flow gallons.
Septic Tank—Liquid capac /./400.gallons Lengthf n.C. Width._.i Diameter Depth.
Disposal Trench—No............ Width Total Length Total leaching area sq. ft.
Seepage Pit No t Diameter/l_X/sue- Depth below inlet....,Z.S 1 Total leaching area..6$0 sq. ft.
Other Distribution box (X)
Percolation Test Results
Test Pit No. I .�
Test Pit No. 2
Description of Soil
Dosin tank�(v
Performed by .ry • rte..,2inl C/,9,PE Date..x5 2•61.-92-
minutes per inch Depth of Test Pit a�4' Depth to ground water...,
minutes per inch Depth of Test Pit Depth to ground water
"re 5414 204 o.4,/ bki 9z-a28
Nature of Repairs or Alterations—A%wer when ap Iicable..,e ehetce .LE�4"
e9t ?— avq,. cH,FC,r 4,GTve rreldeic Itteigr
Agreemcu0
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not 'place
operation until a Certificate of Compliance has been iss.-d by the board e health.
Si d....
- i
Application Approved By
e
Application Disapproved for the following reasons
Permit No
Date
Issued
THE COMMONWEALTH OF MASSACHUSETTS
BOARD AO/F (EM—TH /-
OF AL Olrrtifiratt of &motto P d Hire )
THIS 1S TO CE/i FY e' . th.'Indivi 1 Sewage Disposal System constructed ( ) or Repaired W
,y IIS.
Lt c_ ..
ms been installed
accordance in accordance wit'n th:�.rovisions of TIT1-% $-f The State Sanitary Code s des rihed in the
application SS Disposal Works THIS Construction Permit SHALL No
fa._5 )— dated_ .G. If ya
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S^GU ANJ€ETHAT THE
DATE WILL FUNCTION SATISFACTORY.32 Inspector /�
DATE .! , [( 4Af/( tit
THE MMONWEALTH OF MASSAC USETTS
CA= BOARD
r L
O - i31 LL-vvi 9 JC
No
laispooal,Plogko jEtottotritrtiatt i ttmit
Permission is herebEy�,g�rarr�d. ag , System
to Construct ( ` d� •lue f h
at No
Street
as shown on the apcation for Disposal Works Construction Permit NY
rant-A I /17"1")
DATE
FORM '255 A. M. SULKIN, BOSTON
d...L,(.S.-B
Board of Health
ro C-75/
5
THECOmm N ALTHO
. S.. ..'a
clppliratiun fur Pisposttl ,.gstrm Qtnnstructiun Permit Sg
FEE
aro
ACHUSETTS
MASSACHUSETTS
application is hereby made for a Permit to Construct( ) or Repair O an On-site Sewage Dispo.al System
Location Address or Lot No. ,�/�
/S
J Fe
t
owners Name.Address and Tel.Np.
I
Installer's Name.Address.and Td]o_
Designers Name:Address and Tel. No.
type of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder( )
Other Type of Building No per Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow
Plan Date
Title
gallons per day.
Calculated daily flow
Number of sheets
gallons
Revision Date
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
C
v O K 8-/BiCd
a
■ 'rat
Date last inspected
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance ha: been issued by this Board of Health.
Signed hail:
nrr .✓ a — Date
jay ✓ 7 ,
Application Approved by '!�—r��� � Date
Application Disapproved for the followi sons
Permit No.
Date Issued
THEC�//OMMONWEALTH OF/nASSACHUSETTS
/112\-2-`�-�'-n``f�GG`"'�`MASSACHUSETTS
tertifirate of (Iamplianre
TBrCER TI at the D I e SueEhge Disposal System install 7rlepaired/replaced(k) on
at ) `ei, � t. ' ' i mr YY
at / S I/✓.y-ti- -EC�1.�wyro Lit' c Itclsee uirructed in
accordaneeµv�ith1 thy proyis o!of Title-8 and the for Disposal System Construction Permit No dated
//11-� ll e f this ter co dii neI pt,coryphange yi tb j pJGVision3 set forth,below:
5 p �i pl to t' Y.0
� {/x'12 _k. nrq' �1�. ��Ca_� T r .
1
The issuance of this certificate shall not be construed as a guarantee that thesystem will function as designed. This
Certificate expires o t j
/j , y / ? / ) S fit-, rd"
DATE Inspector
ft( `A7/`j
No.
THE CO ONWEALTH OF MASSACHUSETTS
, . 4.G-r�
MASSACHUSETTS
!ispasat stem C anstrustian Permit
Permission is hereby g(apted to
to co rfc({ ) or repair(A) an On-site Sewage System located at
FEE
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construction most be completed w/itt% 5t o-years of the date below. " �u� ! ____
DATE / ' I ( z / / / / J Approved by
FORM 1155 Rev.a n A.M.SULKIN 7(-BOSTON.Mn
°'q' /w Aq
7` eV CJn f o';u d y/ AGN
p fouvyfsa / C � p-77 p7a/;zy; f/? 1vSQQt
// j a>-o cis/O d!urns
hoof-I(ag 4WO)0y,;" u04
Ge S/i a.7 cy ay-c.r hF. ,
a boN 4'n/diVN%J1/24
C /O'wt fY 0q SL_
,17?8/ P/?'d / rsoa5id _.„_.
I ■
i1
V-1 7i t°7
/
I
D
THE COMMONWEALTH OF MASSACHUSETTS
/ ) BOARD OF HEALTH
Gat OF AccrifigtoAlci).
) pplirutinn fur Marks Qluimtrurtinu jirrutit
Application is hereby made for a Permit to Construct (x) or Repair ( ) an India idual Sewage Disposa
stein at: IL
itlesfh.a.n1,ehJ2 t. s /o
Lr( Inrmioa. t
ate E NaL/Lit Addre
Owner
or Int No.
Zl__Winch._Alv Mf/ 0/027
Address
Installer
ype of Building
Dwelling—No. of Bedrooms 3
Other—Type of Building
Other natures
esign Flow 3-0 1.1.2. gallons per person per day. Total daily
eptic Tank—Liquid crpauty ltCg:dlons Length Width
isposal T- - *r--_F. !/g'— Width Total Length al'
eepage Pit No Diameter Depth bel ow inlet
Cher Distribution box ( ) Dosing tank ( ) ,. / ,O q
ercolation Test Results Performed by hi..J:.a }j.+-/L.!L,reb n..1., Date .5-- 23- 1 3
Test Pit No. I lit minutes per inch Depth of Tt [ Pit 6 �1' Depth to ground wate- J10ne
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
lescription of Soil.L' —/L° ICI' Stil QL dOC,f.P ,,,_12' — Y1. SJl/t/ SQ/Y L/ SAf
!LL.m
Address
Size Lot /, POO Sq. feet
Expansion Attic ( ) Garbage Grinder (✓) yes
No. of penoic Showers ( ) — Cafeteria ( )
flow 300... gallons.
Diameter Demi, Ss-lid
Total leaching area..- n- sq. ft.
Total leaching area sq_ ft
Tature of Repairs or Alterations—Answer when applicable
.greemcnt:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
fie provisions of Article N1 of the State Sanitary Code—The undersigned further agrees not to place the system in
peration 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
Date
Date
Date
Issued
Dam
et
THE COMMONWEALTH OF MASSACHUSETTS
FES../ • c-o
�
BOARD OF HEALTH
%etc:( OF "t
Appliratinn for flispnstti Works Cnuunstrurtinn Permit
Application is hereby made for a Permit to Construct
stmt at:
•
dd
TT{{��''�� �� ���L tiov.e ress
Installer
Toe of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building No. of persons
Other fixtures
sign Flow gallons per person per day. Total daily flow gallons.
sptic Tank—Liquid capacity gallons Length Width Diameter Depth
isposal Trench--No. Width Total Length
epage Pit No Diameter Depth below inlet
ther Distribution box ( ) Dosing tank ( )
ercolation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
or Repair ( -5an Individual Sewage Disposal
Ad r
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
Total leaching area sq. ft.
Total leaching area sq. ft.
escription of Soil Y
wo-tA.
Date
Depth to ground water
Depth to ground water
:ature of Repairs or Alteratipns—Answer yen applicable e� •`
low "' it 7 -rr'r at__i!P^- Ia. J `Y „ee-mo,u-LKtA,.�
,greement: 0
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
to provisions of TITLE 5 of the State Sanitary Code
peration until a Certificate of Compliance has been iss
to
—The undersigned further agrees not to place the system in
ed by the board of health.
fpplication Approved By
Signed •
\pplication Disapproved for the following reasons
Permit No
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
@Tertif ratr of htnmplianrr
THIS IS TO CE i IF That r vidual ew-age Disposal System constructed ( ) or Repaired (
Y
/3
Is been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod s de4cribed in the
pplication for Disposal Works Construction Permit No._-.__-d --f.)-- dated nig')—
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE,THAT THE
IYSTEM WILL/F NCT ON SATISFACTORY.
ATE 4+ 30/? inspector
I � y� wti �nale.�- is t4na.�. iM�Un i�
THE COM ALTH OF MAS ACHUSETTS ,q/
BOARD OF HEALTH °U/I
//' • r, \
Jo FEE
flinpnnat Warku tlnnstrurtinn 1 rrmit
Permission is hereby granted
s Construct t or Repair 0-1 an Individual Sewage Disposal.System
t No . . . � . _
Street
s shown on the application for Disposal Works Construction Permit Nop:j
IATE
DRM 1255 HOBBS a WARREN, INC., PUBLISHERS
Board of IIealth