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0034 ANGUS WAY - Health
3N An9vs way cen`terv;lle 29 1 0 5-z S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR FORESTRY MIN.RECYCLED INITIATIVE CONTENT10ek CoWliedFberSourcing POST-CONSUMER wwwApmgrem.org SFW1290 MADEINUSA GET ORGANIZED AT SMEAD.COM 7fo E l� 'a, LOCATION SENT PERMIT NO. VILLAGE I N S T A LLER'S NAME i A09ItESS O F (`to L 5UILDEft . OR- OWNER (� DATE PEItINIT ISSUED a L— OPL + APd E ISSUED DATE !: 0 C t bs h I I 30,. No.A...3�©.Z� Fss..L ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.....�.C`3 .►�...............OF....... t. .S...... %\C:•-............--- Appliration for Diipniittl Workii Tatudrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ✓f or Repair ( ) an Individual Sewage Disposal System at: O Location-Address or Lot No. _...�:�..........5N:i.`? .-•---•---...--•---....-•----• .. GV�_��........--•--•-------------------- �^ f Owner Address a �_ ._....: s----------------------------- -............._.......... Installer Address d Typeg ® . -- .........Sq. feet of Building Size Lot��_._.�� U Dwelling—No. of Bedrooms......... ............................Expansion Attic ( ) Garbage Grinder PP pa., Other—Type of Building ............................ No. of persons........................--.. Showers ( ) — Cafeteria ( ) a4 Other fixtures ---------------------•........... . d ------------- -------------------------------- W Design Flow............ikQ......................gallons per person per day. Total daily flow........... . ...................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.....--...--.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) -��- Percolation Test Results Performed by.._.-:��Q,-V•.. -�rQ./1:__._....... .....:....... ........ ____ Date...a................................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........--............. G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--..................--. ---•----•-----------------------------------------------------------•-•---------•----......--..............---•--..........--•---..........._...---.......................................................... 0 Description of Soil....Q.=:::i3L _....W-�fYA.......-t........�.( 1.)QS_c!_�_� ----- ----- - .... ------ U .._... U W ----- -------- ---------- -----•--- b' - '--•--•----- ..INk.........-................................................................. . V 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 iI'i L 5 of the.State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance s been issued by the board of Health. gned. ( . ._.. �... . ..._._..__ ..�' .D.. ... ..._ Application Approve y.... .... .. ..... ...:..............................................•-----••.._------ ll . 3 ........Date.............. Application Disapproved t f ollowing reasons:---•---•-----------------------•----.........------.............------.......-------------`-••......-••-•-...... -•--------•----------••-•---•----...--•-----.-•••-•-••••-•--••---•--•----•--•.............................. Date PermitNo....................................................... Issued........................................................ Date Nox..~ �0 Z FEjc... ............... : THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C"o n...............OF....... .0 .c... .. : �=1-�` -------............--------- Appliration for Uiopoii al Workii Tonotrnr#inn Frrutit t Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: }..._CW.. e1��:...... -- ..... ......VWX1 ---------- ---- -------------------------•--...........------. Location-Address or Lot No. .s .................................................. Owner Address a ._..... .nJ .... s-••-•------------•--•--------•----•-... ... _ . . -.__......... •--•- ----------------•------------------- Installer Address d Type of Buildi n g Size Lot\. ��..........O - -•-. Sq. feet ....__ U Dwelling—No. of Bedrooms.._......�............................Expansion Attic ( ) Garbage Grinder Op 44 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................ . .............................................................. ....................................... W Design Flow............�\.Q......................gallons per person per day. Total daily flow__._.__...._.........v.................gallons. WSeptic Tank—Liquid capacity............gallons Length............:... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............-...... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-' •-----._. Date-- Percolation Test Results Performed by.....&sa'u..W—A.......� .......�_ -' q..a 3 � ----- -------•-------------------•-•----.... .aa Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................................ Description of Soil.... "---.... �.l ....... ......._su.)o .t ---------------------..................-.................................... UW ---------------------------------------------------------- ------_--4 __ Vk.-----------------------•-----------------------.....-----------•-----...... Nature of Repairs or Alterations—Answer when applicaa e............................................................................................... -------------------------------------••-----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLij 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance s been issued by the board of health. ;. gned._. �.. Y ------ - -�"•....--=.�-.........._ Application Approve Y .... Date Application Disapproved r t ollowing reasons:..............••----...........................--------•------•--...------------........._............--------•- ---------------------------------••-•-------•------•--------•-----•----------•--......_..----.....-•-•--.--------••-----•-••-----...------------•-----------------...----------------••--•••------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF.........;;�iQL(.nsV 6�6,._ Fk .. . ................................•................ Trrtif iratr of Tontpliatta THIS I TO CERTIFY,, hat the Individual Sewage Disposal System constructed r ) or Repaired ( ) by......... .......'Jfp=-5............................. IIcau at..--------- �......._- o-------------x c� 5------------_ ----- � �- has been installed in accordance with tl rovisions of TI F 5 QThe-_State Sanitary Cod s ibed in the application for Disposal Works Construction Permit No.... �.._.�..4-A.......... dated_, ... ... ... .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S AT SFACTORY. DATE...........................�f0-r� .............................. Inspector.................................................................................... ... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ',. ?,,•-"':.. D. .n.............OF.......... .GtC.(1_s�------......... --................. .....................• FEE........................ Ropnoat Works Taonu n Urrmit Permission is hereby granted----- T�1_t_�1.��..-•---------------•-- ........------------------------------....---•--------................. to Construct ( vj or Repair ( ) ap Individual Sewage-Disposal Systen)_-�., � atNo......... a- '..........��......... .................. ------------ 'dC --- Stl'eet as shown on the application for Disposal Works Construction Per 't o: _ _. ....... Dated_.'r'�... ......� ............. /K Board of Health DATE.// l0 •---------------- .................................... FORM 1255 A. M. SULKIN. INC., BOSTON 6%w(-LG- FAMtL`? S gEORnoM 40z'o-s ►Jo GACt5AGE 69jwD612. o�,►�.�( F%mooW s 110 x 3 = Z30 G,P. 0' q4.3 q9 Z SEPTIG 330XI50'/• USE. l000 GAL. _44 o%,5Po-4AL PIT vsE 1000 GAS. 5Ipc-w&" _Ar A 22L IF UOTT m A¢m4 * 1 3 s F q9 tt3 -4 `,0 . l (3 &PD Tvt-Ac. �eSl +�(�"l l�PD ,r I .j�oua�f�TtOiJ Ag. PERCQ►-AT10N RATE= I''IN VAIN o�.t-�55 �g a POP 59 TK G)(P. Prix P• �N of M,�p-c j0 OF 'W4,rj Aae.p. Prr 101 .1 RICHARD �,� q�' ALAN Z A. W. 99•L BAXTER Z, o l JONES �No.240480 0. ?5'-0 1 t�Q•Ga0 t�'QFSt��yp� FG� t',• � . itil j - � 'Pz��- � t'G �• tOD ,ram, 'Top FNUt1od•,o i T E�T 11 Ij4, INS• + MST. INY. rPT%,vbw1i Box Q1�L 5vTc Z I Ooo I NY. TANK G AAt- 9'1 - INY• INV. L'bF P 1•r �,•Z R 7.4• Wl7N G.va �1. vdA LNG D 6T�N 6 OF • II _ S1� G�2TtFICD pLoT PLAN P4ZOFILG lT I LoGA'T1oN GakhGz\./IALE-- ,i $1 IZ No• .SCALE •ScA�E ` ►(� �' SAT{-c �� - �"�3 a t.UaTioz— �>7p� p 1_P.r.� R E F E cz.E N GE I GE R•T1FY THAT TNE• (ZDu�1`�l�5No1rYN N<r,RCzON GOMPt46 WITH -CHE A►.1� SE-te,�,GK ?-�F-.�'�Q,�010 l6MENT> '(o W N O F ,(�:- �►{ A3(,$ A�ND 1 S (I E LOC.p.-rED •WITNI 'D AT>✓ 1(-I-S'3 � "� B A XT E iZ a IJ`(6 I N� REG 1Srv6.QErD,I-Aw0 5u9-v6Y�es Tiny PLAtJ 15 NorT 4n5c D o►d AN �I }IN1 S-I-R^..r• '115FDT0 CAE-TEtiZlIN�E LcT -II-IE�j APRL►CA0-3TE2VILLE Yr ( T E ►=F, ETS SuoutD uME T ^ •K- A 55.