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,11" 111", THE COMMONWEALTH OF MASSACHUSETTS • _ pc \.\"",,\\ Of ~r" II,

BOARD OF HEALTH d--~- ",--.,.<..,'t-\. • ",tJ'J'. "" ,

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.Appltratiott for lIli.!Ipo!ml lIork.!I QIott.!Itrurtiott " ;;: ~ L ~ ~ ~

Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individ~ age Dispo $ ? ...... ~ .(>'

................................. /,.,.~r.L4 .............. ~~~~_~"\'\ sf; f, ~ 1-'" No. 1-

System at:

......... .5h.j&.:t:.U.k.'d.r.~ .... gO.Ac:t. ....................... .

........ ..B.L.d . .o,. ......... .A~;i~~t.::: .................................. . ..ls:.ir ........... ~ .... !!:-: ...••• ~.r.r.:.-R •. -!?,: ••••.•.••••••••••••••••••••••••••••..

········~·,···~·F.:·····~2Z,~C..±c~...... .............. . ............................................ :;;::~: .. ·8······:;4······;;k;:o:::r· Type of Building , / Size Lot .....• ~ .................. ~I

Dwelling- No. of Bedrooms ........... ':t ............................. Expansion Attic ( ) Garbage Grinder (vf Other - Type of Building ............................ No. of persons ............................ Showers ( ) - Cafeteria ( . )

Design FlOW .. ~t~~'S:'~s .. :.::::::::.::::~;;ji~~~·~~;·~~;;~~··ii·?~;~···T~;;;j·d;;i;·fl~~~·.·.·~·::~·&~~Cr:~~~~~~~~~:· ... ~·.:~:;ii~;-;;: Septic T~i~iquid capacityl',(<?")gallons LengthL .. s, ..... Width .. ,>../ ........ Diameter . . ............ Debb~"""'" Disposal - No ..... 1... ........... Width.SO' ........ Total Length ... &;O./ ....... Total leaching area.1.4r ............. sq. ft. Seepage Pit No ..................... Diameter. ................... Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box ( ) Dosing tank (1 Percolation Test Resu1t;..- Performed by ... F..A .... F..!.L~.Q.~ ..... r........................ Date.~4., .. ':I..f .. J.9..~<{ .. .

Test Pit :\0. ] . ../.,;;) ....... minutes per inch Depth of Test Pit...7~./ ..... ... Depth to ground water.N.O.!I ....... .. . Test Pit No. 2 ............ ____ minutes per inch Depth of Test Pit .. __________________ Depth to ground water ______ __ ______________ _ _

Description of SoiL...£ri::;;);;::r:i.i??:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............. ::: .......... ::: .......... : .. : .. : ...... : .. : .............. : .. : .............. : ....... .

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 ':'ITLE 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.

. . (JtJ/~d ... ~ .... ~ ... ~ ............................ r=.9..~;Z6 ......... . ApplIcatIon Approved By ............................ ..1)~....................................... . ..... s::: ... 2.~ .......... .

Date

Application Disapproved for the following reasons: .......................................................................................... .................. ""

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

.......... TDHN ............. ... ... OF . . ... .. ~.tlHERSI .............................. .

QIrrttftrtt1r of atomplittttrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( x) or Repaired ( )

by ............ L&f .. CUtJS.IR.LlCJ.IO!L .............................................................................................................................................. . Installer

at ................ S-hu.tes.\)U.r.y ... Rod·d·····bo.t ... l-6-............................................................................................................................ . has been installed in accordance with the provisions of TITLE ~ of TlJe State Sanitary Codys descr~ged in the application for Disposal Works Construction Permit No ............. 0-.6 .. ~ .. tff........ dated ... .. t2:2 .... ¢.9. ... f.ft? .............. .

~:~::E.~.~£;y.~~~~~~~.~~~~~~~~~ ... :~ALL I::::: .. ~.~:f~~:;;:.~~~ .. ~.~.~~.~~~ THE COMMONWEALTH OF MASSACHUSETTS

NO ..... Jt~f.. ~Q ........ . Permission is hereby !~e~~.~~~~.~}je~JI~~~~.~.~~~ ....................................... .

:~ ~~~~.t~.uc~ .. (.~ .. ~~.1.~ .. ~)4~~ .. ~~~~a5.:;s/?s;!.S.~~.terIl .... u.'O'7.!.~u ... -::4,.SD.C~ .......... .. 5,,.,, "".u 0 .c:. ~

h h 1·· f D' al \" k C . P . N ~-"7<T D d 0 ~ -Q "" as s own on t e app lcatlOn or lSpOS 'vor'5 onstructlOn ernut o. ____ ~ ate __________ . ___ ________________ ._. __ . ___ .

........................ J!..e ... B;;;;d.~~~iili ....................................... -.1.--'1 ge:, DA TE ....... ~ ............ ::: ..................................................... .

F O RM 12.55 HOBBS & WARREN. INC., PUBLISHERS

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--.-----------.. 1,;;.;;;,-;,,--...................... -.... -.... ························-········-··--··.<dd;;;·;···Z· ..... ;;j ...... ;;r;;..;;i.:J .. Type of Building , I Size Lot ....... ,,? ................ :5q,·-fed

Dwelling - No. of Bedrooms ........... .':t ............................. Expansion Attic ( ) Garbage Grinder (v1 Other - Type of Building ............................ No. of persons ............................ Showers ( ) - Cafeteria ( . )

Design F1ow .. ~~i<.:1:: .. :::~:::::::::::~i~~~·~~;·~~;~~~·ii·i~;·.···T~;;;j··d:"ii;··fl:~~~:·.·.::::·::~:za,:):·.·.::::·.::::::::::·.~il~~~: Septic Tan~ - Jtiquid capacity/J::c.x.?gallons Length.Lus,um Width .. ,s.:.~uuuu Diameter..u.mumm Degb~.m.m. Disposal ~ -!' o .... .1. .. __ .. _ .. Width . ..3.o~ ........ Total Length ... ~.Q.~ .... _ Totallcaching area.lZ ............ .sq. ft. Seepage Pit 'N' 0 ........ . ............ Diameter .................... Depth below inlet .................... Total leaching area .................. sq. it. Other Distribution box ( ) Dosing tank ( .J . Percolation Test Resul~}- Performed byu.r..A .• uE;.L~.Q:::!uu.r .. u .... uu .. uuu .. u Date.~f.,u1..ful9.~""<{u.

Test Pit No. L.I,::)uu ... minutes per inch Depth of Test PiLI~.~uuuu Depth to ground water.N.ONu"uu ... Test Pit No. 2 .. _._u ... _ .. minutes per inch Depth of Test Pi!..uuu .. uuu .. u Depth to ground water .. uuu .. uuuuu .. u

Description of SoiL~_£.n=Z7.;;::ri.Q?::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::=::::::: __ ~: ______ :: __ .~: .. :: __ ....... ~.~: __ :::: .. :::: __ : .. : .. : ____ :.~::.~ .. :: __ : .. :

Nature of Repairs or Alterations - Answer when applicableuuuuuuuu .. uuuuuu .. uuuuuuuu .... uuuuu .. uuuuuu ... u .. uu .. uu'"

. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with

the provisions of ':'ITr..:: 5 of the State Sanitary Code - The undersigned. further agrees not to place the system in operation until a Certiticate of Compliance has been issued by the board of health.

Signed .. uuu ........ uuuuuu .. u_ .... u .. uu .. uu .... _ ..... ___ ............ u... .. ............ u .... u .. u_ .. .. D.ate

Application Approved By ........ u ......... _.u.uu .. uuuu ............................... uu ........ u ..... _ ..... _ Date

Application Disapproved for the following reasons: .u .. uu.u .. u .. uu .. u ....................... u ........... ~u ........................ uu .. uu .. uu __ _

Date

Permit No .... ______ ..... ____ uu. __ Issued..._._uuuuuuuuu_u._._ ... _._ ..... _ D=

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

.:._._ ...... IOJdU ................. OF ... ......... ~lHE.RS.L ........................ u ..... u .. u ........... u .. .

<!!rrtiftru:re of <!!ompliuurr THIS IS TO CERTIFY, That the Inci"'idual Sewage Disposal System constructed ( X) or Repaired ( )

by_ ... __ ... __ .. L .. & .. L.CDHSIRU.r.IlillL .. _ ............................................ ___ ... _ ................................................ ___ . __ Installer

aL ___ ... __ ...... _.LDI_i .. .1.6. ... ..s.HUIES.PJJJl.L.ROIUL. ............. _ ........................ _ ....... _ .... _ ............. _ ................ __ .............. __ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Constr!.lction Perr.1it 1\0......................................... dated .......... ..................................... .

THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON~UED AS A GUARANTEE THAT THE

~:~T:.: .. :.LL.Ltl1..~}:2~.I.~~~.~.~~:.~: ... _ Inspector ...... & ... ~ .... ~ ... ~.~!:. '

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THE COMMONWEALTH OF MASSACHUSETTS. _,pc ,,"'\" OF """'"

BOARD OF HEALTH d-4 ,,"'~""''''\.\. . ":J' ""'"

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i\ppliruttutt fur ili.spu.sul lUurk.s <!tutt.strurtiutt trr Q I', R.S, ;:;: § L :. 688 S

Application is hereby made for a Permit to Construct (If) or Repair ( ) an Individ¥ age Dispo ~ ~ ~

iiiof': ~ ...

...................... _ ..... .-',..rd:..Lfe. __ ....... ::.~·~~to.~!-!!~~'"

.. ls.:~ ... .,fi::.~.t.~ .... _$.t:~~:~.t .... _ .... _______ .... System at:

......... .5.AJd..t:e.£ . .b..~~ ... ..RD.~ .... _ .... _ .......... _

......... .B.~_~D. __ ._~~~~:.~~~ ........... _ .... _ ... _ ...... _ .. .

........ b:.~ .. ~.E. ..... Ca:r...s::t;~ .. :h:c.nn ......... _ ... _ ... . Add~ ••

. ................................ -..... -...... -................................ ;;_ .. _ .•..... IDltaUcr Addre.. 3 l!lJ 1'1"~

Type of Building ,./ Size Lot ..... ,.~ .................. Sq. ie1el Dwelling - No. of Bedroom •.......•... .':t ............................. Expansion 1-ttic ( ) Garbage Grinder (V'f Other - Type of Building ................ c ........... No. of persons ............................ Showers ( ) - Cafeteria ( . )

Design Flow .. ~~~./,~~~.::::::::::::::::;ii~~~·;;·~~;;~~··ii·?~;:···T~;;;j··d;:ii;·fi~;,::::·.::::~~:O":·.·.::·.·.·.:::::::::::~i-;;~~: Septic Ta~ -:- lliquid · capacity/s.:~b'llllons Length.J....;.. ..... Width .. s:.; ........ Diamcter... ............. D~£ ....... .. Disposal ~-~o . .... 1.. ........... Width . ..3.0~ ........ Total Length ... &.O ........ Total leaching area.1:8. ............. sq. ft. Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box ( ) Dosing tank ( . .1 Percolation Test Resul~~ Performed by ... r..A., .. E. •. L~.Q.::~ .... 7T ...................... Date.~(.,.' .. ':l., .. 1.'J.~~{ ...

Test Pit ,",0. 1 . ..I.::> ....... minutes per inch Depth of Test Pit...1~ .......... Depth to ground water.N.ON ......... .. Test Pit No. 2 ................ minutes per inch Depth of Test Pit .................... Depth to ground water ....................... .

" Description of Soil .... E.;,::41o.'J.i9?::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .. : ...... ::::: .. : .... : ........... ~:: .. : .. : .............. ::::::: ..... ~: .. : .. : .. :: .. : ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ; ................. 0# •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Nature of Repairs or Alterations - Answer when applicable ................................... ~ ........................................................ .

Agreement: The undersignod agrees to install the aforedescribed Individual Sewage Disposal System in accordance with

the provisions of 71 T i.E 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 .

. C1kr1;igned ... ~ ... hA ... ~............................ r=.9:~.?.~ .... _ ... . Application Approved By .............. : .......... . f}tJ.~ .. .-.................................. _ ...... &:::.J~ .......... .

Date

Application Disapproved for the following reasons: .......................................................................................................... __ _ ....................................................................................................... _ ..................................................................................... /fiit . Permit No ..... ~ .. = ... ~.f. .... __ .......... ____ ISSUed._ •• i?l.-1-t .. ~/~ :2.(--:-

D ...

THIE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

............ TOI-IN .................... OF .......... i\III.lERST. ....................................................... .

C!!rrtifirutt uf OIumpliumr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( x) or Repaired ( )

by ..... _ •. ..•. l.~ .. .c.c.~!S!P~c. T.!. o.~ ............ _ .................. __ .. _ ............ _ ... __ ........ _ ........................... _._ ........... __ ............................. _ .... _ Installer

at. ............... S.hu.tes.gU-r-y .. -Roa.d ..... l~t ... l6. ............................................................................................................................ . has been inst~lled in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ................................. ~...... . dated ............................................... .

~:~::~.:~~~f.i;~:1.~~~~.~~~~.~~~: ... :~ALL I::::: .. ~.~.2~~:.f;:.~~~_~.~.~~.~:~ __ _ ______ I .

~ ''IF No ..... t1~ ............. .

__ 7~ 'BOARD OF HEALTH ... ~ ... ..r.~v.. ............. 0 1· ......... il7JIlf.~(-= ................................... .. ~4. ......... . Permission is hereby !~~~~~~~~~~~".~~~~~.~y~ .............................. " ___ "

:~ ~~~t~.u.c.~ .. ~.~ .. ~~.1e::. .. b)i..~ .. ~;;;:~a5~.s4 .. ~~~.~: ...... lh.'9. ..... -::41:.sD.r:.V ....... _ .. . as shown on the application for Disposal Works constr~~:~.~.~ .. ~.~:::~S,!.t~~t~~ .. ::::::~ .. ~ ... ::~:=:::::.'~' DA TE ....... ':!l-::.=.!..::.f..~ .................................. _ .. _ .... _ B~,d 0 ,lth

FORM J2!5!1 HOBBS & WARREN, INC •• PUBLISHERI;.

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