66 Applications & Permits No....11— 90
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
AknI
N)
OF
Application for 33inponai Works Tountrn jinn rrmit
Application is hereby made for a Permit to Construct ( ) or Repair
Afar–� R /jo.
System at:
66 6)1-1177-1
w�e.
CCITT- �.iD c.. Y=
.... .... Installer
Type of Building
Dwelling—No. of Bedrooms / Expansion Attic ( )
/ n
Other—Type of Building& ? /A4i.. No of persons
Other fixtures /(� gallons.
Design Flow !LC) gallons per Person per day. Total daily flow De th
``����n-} Diameter
Septic Tank—Liquid cap acity.ye3.Width. Lengtlt�Q Width.
'L Width ' Total Length Sb Total leaching are.'L.:3 0 sq. ft.
Disposal Trench—No. Total leaching area sq. ft.
Seepage Pit No Diameter Depth Blow inlet g
Other Distribution box ( ) Dosin
� Date
Percolation Test Results Performed r inch ._Depth -
(7� Depth to ground water
Test Pit No. 2�J minutes per inch Depth o es t Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit I ground
Sm1..
— g()654)) — r�MPi3LT .i.'� CT Air . .
A o ...
Nature of ep.air. or Alterations—Answer when applicakle wN =. a�
�
akN.4 PA.(L1 &
13 : LSSLie S Unpu t 5y
an Individual Sewage Disposal
mI ,
cJILLI AS'a:\!reCr
Address
Size Lot Sq. feet
GrerIstege–GA*EleTf )
Showers ( ) — Cafeteria ( )
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
the provisions of TIT Li. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been suer}by the board f health.
Application Approved B
Application Disapproved for the following re
ed
1Y ZG,/yo.
n.
Permit No
Issued
n
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qlertifirate of Tomb thtre
THIS 1 / / IFY` TleItiIimIdual Sewage Disposal System constructed ( ) or Repaired (K)
at / / 1 SiAfln�
at (A.�I � provisions .eA-
i. r
has been installed in accord nee with the rovtsions of '_"'.��5 of The State Sanitary Code/14. i the
application for Disposa Works Construction Permit No �( dated '3�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL F CTION S�A(jISFA TOO Y. C,�
DATE /l✓ /9" Inspector Gam'+-`�"
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
fltupuuat nrks QInnntrurtinn hermit
Permission is hereby granted -
to Construct , or Repair (( an Individual Sewage Disposal System
e
at No _ .. .. . .. street i
as shown on the application for Disposal Works Construction Permit No
f
DATE
FORM 1255 HOBBS a WARREN. INC.. PUBLISHERS
FEE
Dated
Board of Health
•
N0.2.Jr.k_....._
THE COMMONWEALTH OF MASSACHUSETTS
�/ BOARD OF HEALTH
c '� OF .
Igiplirttiinn f it T3iiwun ai 31 nrktt Utun.ttirntiinn Permit
•
or Repair ( ) an Individual Sewage Disposal
Fss1 —?• �
Application is hereby made for a Permit to Construct
System at: n� `�,,..,,qq.� ..
ty_h / Y
tat
or Lot No.
Address
_..fCll....AZaae;.S5T� Address g feet
Size Lot q'
Type of Building Expansion Attic ( ) Garbage Grinder ( )
Dwelling of Bedrooms Showers ( ) — Cafeteria ( )
Other—Type of Building No. of persons
Other fixtures gallons.
Design Flow gallons per person per day. Total daily flow Depth
'/� Width Diameter P
Septic Tauk—Liquid capaeiq.r-Q-�.-gallons Length
Width Total Length Total leaching area.�r%Q- —sq. ft.
Disposal Pit No—No. Depth below inlet Total leaching area sq. ft.
Seepage Pit No Diameter P
Dosing tank ( ) Date
Other Distribution box ( ) Performed by
Percolation Test Results De th to ground water
Test Pit No. 1 minutes per inch Depth of Test Pit De to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit p g
Description of Soi
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees of the State Sanitary Code Individual
ersigned further agrees not to accordance
system in
the ration provisions of Certificate ,•b ,,tie udl of irk
operation until a Certificate of Compliance has been I'd -„
Sign e `R - r-wa 1
tom • •
Application Approved By
D ,.if to
Date
Application Disapproved for the following reasons
Permit No._D _et,
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
CJrrtifittttr of sllumpl attte or Repaired THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) P
Installer
has been installed in accordance with the provisions of TITLE
at
application for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT
SYSTEM WILL FUNCTION SATISFACTORY.
DATF
No
Permission
to Construct U
at No
as shown on the
5 of The State Sanitary Code as described in the
dated
BE CONSTRUED AS A GUARANTEE THAT THE
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
tiisposttl Works @Ionstrurtion rrmit
i4,4(ereby granted
✓) or Repair ( ) an Individual Sewage Disposal System
FEE,
Street
application for Disposal Works Construction Permit No
Dated
DATE
FORM 1255 HOBBS 8 WARREN. INC.. PUBLISHERS
Hoard of Health
THE COMMONWEALTH OF MASSACHUSETTS
BOARDy OnF�pHEALThl
..__Cr OF / vf"1 /L..u_'..i°__7"
Ap}tl rntinti fur lIispogai 3Tnrkz Cnnnstrurtinu hermit
Application is hereby made for a Permit to Construct ( ) or Repair (r) an Individual Sewage Disposal
System at:
66 UMI'M
TM 1<d3"2::) ✓•
cJ., ,+z ,p ct°' Y
Installer
Type of Building [ q No. of persons
Dwelling—No. of Bedrooms u . Ft� l
Other—Type of Building f.
j1
! 1 A-n tt „ If
6 6 6-)HL I-Sr mS sir
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ("s--Y--
Showers ( ) — Cafeteria ( )
Other fines
Design Flow 5
Septic Tank—Liquid capacity food
Disposal Trench--No....................
Seepage Pit No % Diameter
Other Distribution box ('---)-
IO
Total daily How i'.45 gallons.
gallons g 1 C:ktSi^K+dth
gallons per person per da . Depth
Mons en tt . ._.. _ — Diameter P
A Total leaching area...3.Q-.3 sq. ft.
Total leaching area sq. ft.
Date 9- 9 - 70
gdth 3� Total Length 8
es1sj16-16Depth below inlet
Dosing tank) �I I
Percolation Test Results Performed by y
..
Test Pit No. 1 -7 T
Depth to water minutes per inch Depth o s it � I ground
water to Depth Test Pit No. 2 minutes per inch Depth of Test Pit De V ground
of Soil tlofiti` tertssta lid l�813/ES
Nature of Repairs or Alterations—Answer when applicable
EXpAA-P t 2 sT,N6 PAILIu.{.-
v..a.kl.( -t-C Sot 16. Q.;3000/.91C- ' ysterA.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
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 bee i ued by the board i ' 9.
Application Approved By
Application Disapproved for the folio
•rZG/ie
n
Issued_
Permit No
Daze
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
rrtifirafe at Tampa rr
THIS O� RTIFY, Tha t Indivi I Sewage Disposal System constructed ( ) or Repaired (X)
by
at (0110 ^
1 _ ,f i r 7P%d
-
has been installed in accordance with the provisions of of State Sanitary Code described� the
application for Disposal Works Construction Permit No fey dated / ,]
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEESHAT THE
SYSTEM WILL FUNCTION V s
SATISFACTORY.
DATE (�
DATE ' ~-% / P 950 Inspector
i /
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
ElitipagO
Permission is hereby granted '
�
to Construct / or Repair ( ) an Individual Sewage Dispos:I System r,
at No Strew
as shown on the application for Disposal Works Construction Permit No Dated
I
nrkn Qlnnsstrurtinn Prrmit
y/). 115�
4_
FEE
DATE
FORM 1253 ROBES a WARREN. INC.. PUBLISHERS
Board of Health