~ •

.# \ ~3~-"~ ' f)cfcf c/.u,; (J c.;-. r-t~s'l<;" 'llflf 1"~1 .~

- --'-f"- • I. .. ~ j I - 'l3" U'r . O()'loj (.f~ v' tr CJP . No. fr-/J / ~R(J~rr.(--9 FEE /YAJ,H!.;{

THE COMMONWEALTH OF MAS ACH SETTS -;-N ;e ~ I'( I? /

Awt#:z: ~sr . MASSACHUSETTS -r (! "'" J,7 -. J\JlJlli.catiuu fur ;!ElisJlusal ~l;!st.em QIuustru.ciiuu Jermit

Application is hereby made for a Permit to Construct ( x ) or Repair ( ) an On-site Sewage Disposal System at:

~~~'/Adre~RAe~~ 73.1./ ~ll ~ AYI-i~~~ 25 G, 341 2.

Installer's'Name, Address, and Tel.No.

Type of Building: Dwelling Other

No. of Bedrooms , ~..f Ga;bageprindir { NdJ- I

Type of Building , ,:571JQ1rl No. per Persons Showers ( ) Other Fixtures /o.L r ,I '- JlC }

Design Flow __ -=-'=-"'-____ gallons per day. CalculatedAaily flow ;;;,~3 . I

Cafeteria ( )

gallons. 1 ""#'\ ",)'

Plan Date --"::tf-~1--/~~" __ ",,ij,!rr\b~ oIA~!!,:el ~ ( Revision Date _-"'--____ _ Title ------'-~=JL..:1..D.~c....::l'---..C.:.J...!£>L ..... ----'--_:_1"-____t'r: ... ~~1AI r.-----

Description of Soil

Nature of Repairs or Alterations (Answer when applicable) . ..,.~--:-:....,..--r--'....--'l

" .., Date last inspected: ____ -"_'-'-"

Agreement: ~ !J L 7 • ~. >< '/ '

The undersigned agrees to ensure the construction and maintenance of t\1e.-aloredescribed dn-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 s been issued b Board f He tho f

~igned ~¥J~:rt....~~!LB4~~Itf::j~~ Date ..::s=-l...,~"",~41.1=:u::K:.L. ____ _

Application Approved_b'~,-u""_-\:;;/;-_~-'U.-{),--<-_~.c..~_I,,-_--,_ Date __ ,-",(,\".~*~,,-______ _

Application Disapproved for the following reasons

Permit No. 9£-/-£ Date Issued ____________ _

TA;MMONWEAL TH OF MASSACHUSETTS

tI~t:S1 . MASSACHUSETTS

QI£rtifi.cai.e of QIompliau.c£ THIS IS TO CERTIFY. that the On-site Sewage Disposal System installed O<l or repaired / replaced ( ) on __

A by ~ -A for at ~ A/("7 ? " DA If k6 h::b~en cons!.tUcted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 'ZA- - /, {' dated _____________ . Use of this system is conditioned on compliance with the provisions set forth below:

certificate shall not be construed as a guarantee that the sy. will function as designed. This

THE COMMONWEALTH OF MASSACHUSETTS

No. ' '1[-//- ttmtl>tSI . MASSACHUSETTS

~isposal ,,~st£m QIoustrudiou J£rmit

Permi;sion is hereby granted to Cv 4/4, t1 &.~ lZt7! A.-to construct ( fJ or repair ( ) an On-site Sewage System located at -4'@J=¥~AL<"<:=--17L.,.::S.l-''J'-~P;...L::L:LL1_r:.F!l=.L. __ _

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.

DA TE ----'-',..,~,L--..L..L-..L~'----- Approved by -~~.k-~~~~7~~~~~r"~~ FORM 1255 Rev. 3/95 A.M. SULKIN CO • BOSTON. Mit

~.

.... .. .' ..

FORM 11· SOn.. EVALUATOR FORM Page 1 of 3

No. ____ _ Date: -.j13- 98

Commonwealth of Massachusetts , Massachusetts

Soil Suitability Assessment for On-site Sewage Disposal

Date: Performed By: ............... 3...~ ... ? .... Q/"!"'"d..J1.d ....................... . Witnessed By: .... J:) .~~.,.c/ .. . 21J.~Cl:!~ II..................................... ... ..... .. ...

'---.0.. CJI'IJri.'19 HRA"L.4-I.," 7 'i 'f ;;j''</ Y te..;J./

~ew Construction 0 Repair 8""" Officr Rmew

()wowf ', Namo.

Io.OCrUI . &IC

Tciq:ll'loN I

Published Soil Survey Available: No D .Yes D

Year Published Publicat ion Scale Drainage Class .. Soil Limitations

Surficial Geologic Report Available: No DYes D

Year Published Publication Scale Geologic Material (Map Unit)

Landform .......................... .. .

Flood Insurance Rate Map:

Above 500 year flood boundary No DYes D

Within SOO year flood boundary No DYes D

Within 100 year flood boundary No DYes D

W ctland Area: National Wetland Inventory Map (map unit)

Wetlands Conservancy Program Map (map unit)

Current w~ Resource Conditions (USGS): Month

Range :Above Nonnal DNormal o Below Normal 0

c..YIJ-r4 ,,,,' frI Ul()S'€"

7 3"/ (flllY~" ./ aJ~- iJ~/ ~

Soil Map Unit

0Iher ~ Revicwe:l: _______________ -------

FORM 11· SOIL EVALUATOR FORM Page .2 or 3

Location Address or Lot No. ___ 7_J=-","--_B-""-.:.~-,,(,-----,;t?.:..:;,..;;;,,._.{=-

On-site Review

Deep Hole Number .~ " ,. Date: Time: Weather

Location (identity on site plan) ...... ''''',~~ . "' • yy~ ........ .................. . ~. -~ ••

Land Use "~" .. _ Slope (%) Surface Stones Vegetation _,_ .. _ ... .

Landform . .. . " ..

Position on landscape (sketch on the back)

Distances from:

Open Water Body

Possible Wet Area

Drinking Water Well

.

feet

feet

feet

Drainage way

Property Line

Other

feet

feet

DEEP OBSERVATION HOLE LOGO

Depth from Soil Horizon Soil T extute Soil Color Soil Other Surl.ce (Inches) IUSDAI [Munsell ) ~onllng [Structure, Stones. Boulde,., Consistency. "

Grtvln

() - !}) ;! Sf.. /Oy,,~ 3']

;;3' -/8 1J(;U S'- VI y/l. % ";;)(/ ib /Pir'<-.

'~~F-- .Jl) 2; z.-e/

/.9 - /Oy-<Ji'y c:;:-,rRfJrn,..'(/ c:;~ /4}- c: c~ J7Z IV<" -I c!P- .Jh. I 1';,...A

/t1y~-% .J,

'''''' I'1VU:~ 'A'<V<~' <REA

- -,-Iogic,--------------:. PORth!P Groyndwat.r: Standing Wow in the Hoi.: ___ .:..~_____ WHI'inII "om Pit F_: _______ _

_ SeosonoI High Ground W...,::::::=:::::::-__ -"-------_____________ -:--'-___ _

FORM 11- SOIL EVALUATOR FORM Page 2 of 3

Location Address or Lot No. ______________ _

On-site Review

Deep Hole Number ._.. ..

Location (identify on site plan) Land Use __ . __ . ""

Vegetation ~ ..... ' _

Landform .. ••. _ . •

Date:

Slope (%)

Position on landscape (sketch on the back)

Distances from: Open Water Body

Possible Wet Area

Drinking Water Wen

feet

feet

fee t

Time:

Surface Stones

Drainage way

Property Line

Other

feet

feet

(§J) DEEP OBSERVATION HarE LOG·

Oepth from Soil Horizon Soil Texture Soil Color

Weather

Other Surt.ce IInch.5} (USDA) {MunselH

Soil ~onhng (Structure. Stones . Boulders. Consistency, "­

Grevel)

17

/17 (

I U" HUU:~ IA I tVOKY __ (oeoIo9ic'___________ DopItiIDBoaocIc. __________ _

Qoptb!p Grayndwllllf: Standing Wow in Iho Hoi. : ________ WHpOng from Pit FoCI: _______ _

EsIimoIad _ High Ground Wller:, _____________________ -'-___ _

DEl' APPROVED rolM· Ul07"S

FORM 12 - PERCOLA nON TEST

Location Address or Lot No. ____________ _

COMMONWEALTH OF MASSACHUSETTS , Massachusetts

Percolation Test*

Date: Time: . , , , "', ';;;;- --1\ Observation Hole # / Depth of Perc Cd t"- V $7 Start Pre-soak

p~,;;u' I End Pre-soak (~

.... "'1(/ /

Time at 12" v ! '7" \ ..j ./ p / ~ Time at 9" (J '.?-j "- /'" -~

Time at 6" r- Vi "--

Time (9"-6") ~-

Rate Min.llnch r~/ '- --• Minimum of 1 percolation test must be performed in both the primary area AND

reserve area.

Site Passed 0 Site Failed 0

PerlonnedBy: _____________________________________________ __

Witnessed By: __________________________________ ----------------

Comments:

DD' APPROVED FOaM· um195

\ 'f "co,;UU- -rt:.. II? /iAJHO LLS

..5c~ IUC7ZS

; .'

FLoo R:.

P!lCPOSED FCI.NlA T I Oi WAll. CF STUlIO.

7/. /0 77.66

PROF I LE OF SEPTIC SYSTEM WITH INVERT ELEVAT I QNS

No Scale

.... ::: .

~q,D

-.. ' '6;\iiJi -M.~;~RrAC . . ,- '," :-.. '; -. :;f7.'~O·

. '. ~o r -.... --'---- _., -, - .-'-'.:-; ,: 1/8" TO 1/2"

DOIIBLE WASt£D STONE

f.'-'-'--'-,...~4 .:.76;8;C " ~ 'rb ;'f'?-

.' _ . .., ....... ,. : .. - -

96 ·'1'1

. i 1

.. " ELEVATION: 100. 17

'76 ·26

'f.::,- ' ---~;.I

'77 I ;;-1

so I L Lc:::x3S .

SOl L TEXlUlE

MAY 13. 1998

A 0-8 SL

Bw 8-18 SL

e 18-142 CS&G

10YR3/3

10YR4/6

10YR5/4

1flTli.1~

NONE LOOSE SINGLE .: ..... . ~'. .. OBSERVED GRAIN ' STR4TIFIED

LAYERS , STONES <::RAVEL , CX>ARSE

SAND, 20% STONES " ",. ; "

',,': .. ." '

. ;;;;:~;:,

.:',.'

.'.':" ;

~ '-",--' " ,"~"'.'

..... ,.

, _''' 0'_

3/4" TO 1 1/2" DCUlLE WASt£D

STONE

. ' CROSS SECT I ON C>F' LEACH I NO TRENCH_ WITH ELEVATIONS SHOWN AT D BQX

_~-;-scal~_ .. _____ _ • ~ ...... ~ •• o •• _ '

i>1... 173 I ,

.'."" ,-",~,' ~,"'- ~ , -",- ,,:" " 0( ' 0. '.

\

2 ELEVATION:

100.43

BOTTa-t q' Hl ELEVATION = 88.33 WEEPI~ = NONE; ESTlr1I>.TED ffiOO!oID WATER = >142" LEIXE = > 142" NOT IN FL<XX> PLANE '

MAY 13, 1998

A 0-6 SL

Bw 6-17 SL

c 17-137 CS&G

BOTTCt1 CF H2 ELEVATION, 89.01

lOYR3/3

1OYR4/ 6

lOYR5/4

WEEPING = NONE; ESTlr1I>.TED ffiCUNI) WATER ~ >137", • LEIXE = > 137" NOT IN FLCCO PLANE

--_ .•... _-- _._- -

NONE LOOSE SINGLE OBSERVED GRAIN STR4TIFIED

LA YEAS, STONES ~VEL , OOARSE

SAND, 20% STONES

.-... . . -- ,------ -_._-.-- .. -- - _ .. _- ----------~---

~

•••••••• '. __ • • _ _ . _ ._..: . :_. '_ . • •••• • 0

734 BAY ROAD , 62000 SQ FT AI'PR:lX

SCALE 1· - 40"

- ;!.. ..

.. ...: .. " ..

...... -."' .

o BElCH1ARK: Oi GR.&!lE AT CXlRNER '"" CF BARIL RELATI VE ELEVATIOi = 100.00 ~= EXISTl~ fOJSE. '

@ 1500 oo..L.C'M ' SEPTIC TANK.

@= PR\X1SE1l STUlIO.

(9= EXISTI~ BARN.

G= DRIVEWAYo

--~~:----------~

/'

LOCATION OF DEEP OBSERVATION Ii1E l.OCATiON OF PERC TEST WELL POSS I BLE WE11..AII)

104 EXISTING ~ 104 FINISI-£D ~ EP EDCE OF PAVEl'ENT PL APPROXIMl.TE PRU'ER I Y L I HE

\~\ _~_2~;_' ____ ~~ __ ~ \\,! P ______________ -L __ ~_£P

\:, % -OfU; Ko l~D -::::>~-i'? n£·OES-;~· OO-II£ER--HJsT 'INSPEcr ;u--. - [> <XWONENTS CF Tf£ SLllStRFACE ABSOOPTION

SYSTEM PR lOR TO BAa<F ILL I~; TEL: 413 467-7228 15.021 (3)

" "

. .. .. " .: . .

!OlEs: '

FIRST 2 FEET C1JI' a: 0 BOX TO BE LEVEL. Ell) CF 0 I STR 11lUT10i LI NE TO BE CAPPED. BOlT01 a: 1REIOi TO BE lEVEL. AlL STCNO I S TO BE DCUlI..E WAS!£) . SEllER PIPE FR01 S1W 10 TO SEPT IC TAN<

I1JST HAVE A SLOPE CF 0.02 NCl /'tJST BE 4 IICH seLl 0 WALL PVC.

PIPE llET'oIEEH SEPT I e TANK NCl 0 I STR I BUTIOi BOX Ism BE 4 I t«:H SQ.ID WAll... PVC:, SUPE 0.02.

OISIRIIlUTIOi LINE IN TREICH IS 10 BE " IICH 0 I N£TER PERFORATED PVC PIPE, SUPE 0.005.

SEPTIC TANK 'Nt> 01 STR 11lUT10i BOX /'tJST BE SET, lEVEL NCl TIllE 10 <R.&DE. Oi A LEVEL STABLE BASE CF STCNO 6 I NCf£S TH 10<, "'ICH HAS BEEN ~ICAlLY <XWACTID.

I F lOP CF SEPTIC TAN< IS I-<JRE 1llAN 12 I NCf£S BEL.aIf <R.&DE Tf£ SEPT Ie TANK I1JST HAVE 3 .<CCESS tWH:US WITH A 11 I N 111..1'1 o IN£TER CF 20 I hO£S NCl BE FU.lSH WITH GlADE: ONE IWHl..E EACH a.reR I i'I...ET 8AFFl£. OIJTLET BAFFLE J,JC

CENTER IWHl..E CF TANK • Tf£ lOP CF AlL SYSTe1 CCK'a£HTS SHALL

BE t«) I1:JlE 1tWI 36 I N:I£S BELOif FINIS>ED l'I!.&tE •

IlLEr AND C1JI'LET TEES SHALL BE c.\ST I RaI. SQ£l1.LE oW PVC OR CAST IN PUoCE cx:tO!ETE NCl BE Oi 11£ CENTER LItE CF Tf£ SEPTIC TAN(. CRlSS sa::naw.. FLOIf 8AFFI..ES SHALL lOT BE usa> AS SlBSTITUTES PER 15.227 (1). III.ET NCl C1JI'LET TEES I1JST BE LOCATED AT CENTER CF TAt«. EVEN IF EHTR"( IS 11-R.I Tf£ SlOE a: Tf£ TANK.

SEPT I C TAN< C1JI'LET TEE I1JST BE EQJ I f'PB)

WITH GO.S 1lAFFU. GO.S BAFFLE SHALL BE I NSTAlLED so THAT BOlT01 IS 1r BEL.aIf L I QUI 0 L tNE NCl HAVE 90 ceGlEE B..BCM CLl..ED IN PL..ACE, POI NT I N3 itlIfARD CENTER CF SEPT IC TAN( .

!Xl tor USE ANY SEPT I e TAN( I F IT HAS A HOLE IN Tf£ 1lOTTCt1.

D I SIR IIlUT I Oi BOX I1JST HAVE 11 I N 111..1'1 INSIDE DU£NSIOi CF 12 1NCf£S WITH A 6 IICH stH'.

o I SIR IIlUT I Oi L I toES Fal TREICHES SHALL BE SQ£l1.LE oW. I F to VEH 1cu..AR 1lW'F I e IS ANTICIPATED sal 3S MAY BE USED . 15.251 (5).

AlL SEPTIC TANKS AND DISTRIIlUTIOi BCIXES I1JST BE WATERTI Gil'.

. '''-' ",' ..

EXCAVAlT'OO ~ PR<:>V10E A SWALE 5 FEET W I DE i\RCl.Nl SAS TO PREVENT SUlFN::E lCATER RtH:FF FRCl'1 ORA I H I r-o CN NE I CJ-BOR I tG PR\PERIY .

IF l.fIX!E IS ENCCUlTElED HI G-ER lHAH ANTII CI PA TEO 00 H IG£R T'HA.H OOSERVED I:X.RlItG EVALUATIOI CF DEE? OOSERVATI~ H:X..ES, FILL /'tJST BE IO:£D TO RA I SE 1l£ BOTTa'1 OF ll£ l..f.IoO-ll N3 SYSTEM AT LEAST 4 FEET /oW:HE 11£ HI G£ST El.E\YATIOi CF LBXE FO..N>.

_ PAIRT CF 11£ SEPT IC SYS1CH THAT WILL BE $I..8.£CT TO VCH lo..uR TRAFF I C I1JST HAVIE AN H 20 ~ LOoI\D RATI~.

IC lIEULS CSSERVED WITH I N 150 FEET CF PRIU'OSED LEAaiI~ SYSTEl1, <mER THIAN !HlfIN.

"'PRCPER .... ""W OIII£R IS RESPCtlSIBLE Fal CXK'I..IAICE WI TIH AlL u:cN.. ZDlI ~ RS:U.AT IONS, CCN!SCRVATIOi CXH11 SS I Oi RE<ll.AT I ONS NCl ' HASSACHJSETTS YoET1..AIC> f'RO'IR:TlOi 'CL

PRCPER,I '( L I toES I1JST BE ESTAIlL I S>ED BY A RlEGI STEREO ~ SI..RVEYCJ! I N altER TO IMAI NTA I N PRCPER SETBACI( .

,., CRI'VEWAY, PARKIt«3 AREA CR 01l-ER It1'IERV IQJS SUlFN:£ SHALL BE LOO:ATED N3t:NE 11£ L.£N:H I t«J SYSTEH

", -< ," EXCEPT IOt£RE I TIS LNA\'OI DABLE. IN su:lH CASES verr I t«J I1JST BE PRESENT_

IN( lImlK mE BY PRCI'£R I Y OMER lESS 'IHtoH 1001 FEET FR01 A WETUI'I> WILL REQ.J I RE THAiT f£ FILE A IOTICE CF INTENT WIlli TIE l.OCAL ~ATIOi CXH11 SSIOi .

IC SCl"TIC SYSTEM M:O 1 T I YES HAY BE PLA/:S)

IN A SEPTIC TAl«. 10 pNfrT CF L.£N:HI ~ SYSTEl1 CAN

BE ux:A.TED lESS lHAH 100 FEET FRO:t1 J.H( WElL OR EIXE CF A WETUI'I> OR lESS 1llAN 10 FEET FR01 Nffl PRCP€R I '( LlI£.

FfUJER{ I T CItIt£R IS RESP'CHS I BLE FOR FI~ISH CRAOIt«J NCl SEEDI~. EXCAVATOR 1 S RESPa<S I BLE Fal BN:KF ILL I ~ NCl RCl.Gi CRAO 1 ~ lR.ESS on£RW I SE NEWT I ATED W 11TH PR<RER I T c:JIftER.

lH I S SEPT I C SYSTB1 DES I ~ IS f¥}T I~ TO BE A SITE P\..AN.

EXC4VJUI t«J CCJ<TRJCTtlR I1JST CAlL OIG S.&."'E FaR a..EARAICE 8EFalE START I NG \I!:lRK. TElL: 1 BOO 322-4844

IX> tmT s::AL£ DRAW I NG •

'-

.. ,~ .. ' ....• : .. :.' .. : :,.

:.. . " ~ .. " :.; .. .... . .

SI1U!>TlON:

2000 SQ FT, 2 FLOORS, (1000 SQ FT 1 FlOOR) S1W10 Btl I LOINCl, ItO GAIIBN:E G! I IllER , PERC RATE AT HOLE 1 'CF' 2 \ HIIUTES PER IICH. OCIP 62 I N:I£S, PERC RJ.TE Arr HOLE 2 CF 2 11 I lUTES PER IIOi

~ . . OCIP 66 I hO£S . DEP WESTERN REG ICNAL CFF I CE RSXI+EI«lS ESTIMATED AVERAGE MIL Y FLOf CF AT LEAST 150 <Vti ell 75 G/ H SQ FT. I!Cti AI1f£RST RE<XJ1'£KlS 2:2(l.(PO EST I MATED AVERAGE M I LY

FLOf.

PERC lEST MTE: MAY 4, ,1998, BCWD cF ~1ii lIIln£ss: ellc a3..SH. SOl L EVALUATOR : RCBERT F. S!£EHAN, CERTI F I ED N:l\I9'I!ER 1994.

220 ~ PER MY = ESTIMATED MILY FLOIf.

LaOi I NCl SYSTEH I S TO CONS I ST CF 1 TIlEN:H 3 FT WIDE, 45 FTr l..CH3 WIlli A 111 N 1"-" CF 2.00 FEET CF STaE LNlER 11£ D I STR I BlJTIOi LI NES .

. DES I (JIl P!I a I AT! C»IS :

SIDE = (2) (2.00') (45') (1F 180. SQ FT X 0 . 74 G / SQ FT ~ (1) (45') (3') = 135. SQ FT X 0.74 G / SQ FT

TOrALS 315. SQ FT 1995 TITLE 5 LCW>IIC F.&CTmS USED FOR CAl.O..lJ.TlONS

= 133.2 = 99.9

233.1

. "':'.

. . - '. ' -.

STUD 10, REAR OF 734 BAY ROAD ./AMHERST, MA

Sl-EET 1 OF 1 I Approved by :

. BCW!!) t:F t£AL 1H 5/29/98

SEPTIC SYSTEM CYNTHIA KRAUSE,

DESIGN FOR AM-IERST, MA

Draw; ng NLlTber

. ... '

R _ F _ SI-EEHAN ASSCCI AlES IIC ••

~. MASS . 98143 PDN I,

.. .. ... ..... ,

........

~<l"ty. ':' "i)-~~:!;':~

];L~i;.ili~

, . - -- ..

, , ;!~~&~,3~

~~~~?frH~":~':':~~t~

2]~~~~jZJ,2~~i:*

I

~

~ • .,

INTEGRITY DEVELOPMENT & CONSTRUCTION, INC.

110 PULPIT HILL ROAD AMHERST, MA 01002

(4131549-7919

MEMO: krl,~ &pci fx1c fr<1r- ~/,«HS:

~ First Massachusetts Bank 5J.2I3Ill]

1I"002bI.811" 1:0 ~ ~:l0 2q:l :II: ~1.0b 122111"

--~--.--

2648

0};!r 41'\ 1)/1 ('

$ /ba0r2 DOLLARS

SI:CUAl1Y FEATURES "'ICRO PRIN! TOP t. 1101 10M AQrlnrn l'> t:Uflflrn PATIEnN· ARTIFICIAL WAIEHMAAK ON Il[Vl IlSE Slot · MI SS!I-IG FLAlUllE INDICATES II COPY

~ •

!

• !

II

I ~

~

•

•

TOWN OF AMHERST HEALTH PERMITS! INSPECTION SERVICES

-- 1> Received of .1. IV I~ 1N1:1 y (OV ~ I" nt',.,"" For Property Located at: ., :.s 'f a fl 1 t,." ,.. {>

Street Address

HEA009 Bakery R6510 443508

HEAOOI Bed & Breakfast R6510 443516

HEA025 Burial Penn its R6510 443517

HEA002 Catering License R6510 443507

HEA003 Food Handler ROSIO 443515

HEA004 Frozen Desserts R6S1O 44350]

HEA024 Funeral Director License R6510 44)502

HEAOO5 Health Dept. Housing Insp. R6510 432302

HEAOO6 Massage Therapy License R6510 4435G4

HEA007 Milk & Cream License R6S1O 441500

HEA008 Motel License R6SIO 443506

HEAOIO Removal of Offal R6510 443513

HEA01] Percolation Test Fees R6510 432300

/lidO, 00

of /10 1ft I P,' 'H/ tI ~ 12 AddrJs I

C \1 ,,;-; b !;IiI K,{HV.re f Owner

HEAOl4 Retail Store Permit R6510 443514

HEAOl5 Sanitary Code Booklets R6510 432305

HEA016 Septic Tank Permit-Installers R6510 443511

HEA017 Septic Tank Permit-Private R6510 443510

HEA018 Septic Tank Reinspection Fee R6510 432301

HEA026 Smoking & Tobacco Reg. Violations R6510 443518

HEA019 Sub-Division Review Fee R6510 4]2306

HEA012 Swimming Pool Permits R6SIO 443512

HEA023 TB Clinic R6510 432303

HEA020 Tanning License R6510 443509

HEA022 Tobacco License

HEA

HEA

R6510 443505

Chv.4J2 ~Q1 Q

HEA013 Recreation Camp License. R6510 443503

TOTAL FEE: _#J7-J/'-'L'''-O_, 0=----=-0 __ _

Inspection Services/Health Department

... -~- ....

Must be validated by the' Collector's Office to be considered paid.

While - Applicant YelJow· Collector Pink· Accounting Gold· Health/Inspections

0371

•