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SUS NAW
FORESTRY
INITIATIVE
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l0 C A T ION 4-OV2,64fYS SEWAGE PERMIT NO.
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VILLAGE y'
" INST` A�LLER'S NAME i ADDRESS
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.--.._.ow N.... o,.............A P-n)-s.TA.6 Lf-------.-........-........
Apphratiun for Disposal Works Tunitrnrtiun ramit
Application is hereby made for a Permit to Construct (i/ ) or Repair ( } an Individual Sewage Disposal
systeLo 146 Cro�er� 6t C?e # rv� ! I e
........... p . ... ............................... .....•. n-. --------- --------
04. -. .......- • -- ]... 01�...�°�� ... � .
a ' 1 ......gC,Ch J,� e
Installer Address ` ��
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.. _� _Th(�Q��________________Expansion Attic ( ) Garbage Grinder ( )
p`'14 Other—Type of Building ---••0% - No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures -.-----••__________________
W Design Flow - -....---------------------gallons per person jer day. Total�jly ffljtw-----------� 1..--------------•--•--•--1�1$fs..
Septic Tank—Liquid capacity lOW..gallons Length.._. ...._.. Width.__.......1....._ Diameter................ Depth.--..X.
x Disposal Trench—No..................... Width ....... Total Length........___i�..... Total leaching area............ ......sq. ft.
Seepage Pit No.......I............ Diameter.._._.!........ Depth below inlet..... .......... Total leaching area.2b.
Z Other Distribution box ( ) Dosing to (� / QQ
'Percolation Test Results Performed by.......... � .�est
_..�� Q .'�7 ............... Date......_._!__-.�!�-_'.b. ......
Test Pit No. 1___....__ -_-minutes per inch Depth of Pit........-2-._.... Depth to ground water-------[��__..........
(r4 Test Pit No. 2... -...minutes per inch Depth of Test Pit......... ._..._.. Depth to ground water.......!Q...........
O Description of Soil f .: 16CIM_.F.. = �� f ...- �n ..
x r �- r
5 ...- •---•• ipavi l..f,_. O.... ._ .:z,.......1 C2 L$=G �hIM. p !� 4..dak....---•-•---•--------•----..
U .. s
W 1.t.. 4----------?-------P'z---Lo• --...t SuI SOtS-- 6-`/O ry ct- -�SQ�r1d
UNature of Repairs or Alterations—Answer when pplicable.. ......::... ... .......:... ....(V(. ...f rL .
y2 .. .1 .---------l• 6.• �.. �' -
. --•-
Agreement:
Th u dersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the pro '- of ILI 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
op ati until fi , of pliance has been 'ssued by the-board ealth.
` e' Q
Signed-••• .: 1 ...'..-?. .
✓ / / -
Dat
Appli ati pproved BY 1�._.6- � 1 .
ate
Ap ' tion Disapproved for the following reasons----------------------------------------------------•---•----------------------------•---•--•••-•••.......---.._
--•.......................•..--------------------------------...-•-----•-----------•--.......---•-----•----•••••-•..._...•••-----••---••••••••••••••---•--•••--•••-----••-••-•••----••--•-••---••-•---•.
Date
PermitNo.... .It................. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
U✓V I�----------------OF.......:. ....f
ApplirFation for Disposal Works Tonntrnrtiun ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
. Lc�l_�. 'L6 ( rocker ri�..fit C 10il-1 orc.v x, oir LI oe
----.. ................................................................. ................ ......... -----•--•---.....----••-N
-e.....__...--•�---..,....-_.--....
f r 1 Lo doA rl
..:...- ...........--- ---- -----------•---------- ...-----•----
-
a °� �` Co 1 7 C r e((-t i,�),�.�5` ` �e �\ d ................................---.......- ----......... ...
Installer Address
d Type of Building Size Lot_-�._ �' __ ?......Sq. feet
re _
Dwelling—No. of Bedrooms._;._._..................................Expansion Attic ( ) Garbage Grinder ( )
pal Other—Type of Building .....LQ l'7-C .. No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures
d
W Design Flow.......--------�..........................gallons per person per day. Total lily APW............o _��.____.............._.gallIons.
W �S0 Septic Tank—Liquid capacity .gallons Length..�_.11.... Width._.._ ... Diameter................ Depth..,_-.`�..'.
x Disposal Trench—No..................... Width..... Total Length...................... Total.leaching area...................sq. ft.
Seepage Pit No__-__�------------- Diameter.._...�. c. _..... Depth below inlet_....�._........... Total leaching area.G L........sq. ft.
Z Other Distribution box ( ) Dosing tank,.( _)
Percolation Test Results Performed by........�J. _./_.._4�-. .�__ ............... Date......�_:..� ...... s.......
Test Pit No. 1_...'.....Z....minutes per inch Depth of Test Pit------ �._._... Depth to ground water-___-.f-_�__------_--
rl, Test Pit No. 2.. ._ :._..minutes per inch Depth of Test Pit......i.t•'......_... Depth to ground water.......�.Q........__..
D Description of Soil...kacf"-t ,' �=- ..``- GCS 11) .. 1 1 Z..=K..� -i -
'iC�r 1 r� �.(!-S).Yi_�__ .;(!( ��� (Z Y )'! (( it I(1a r U r?I ) C#+1CC
1=� �f
- r) " , {��i.,i t•.. r�l. f?�C� C lc� �7�{ E( (i rl�( ......1(y- } .
U Nature of Repairs sr Alterations—Answer when pplicable._- ... . ...... .. .. ..... -----_. C°- (1_ij...h)LC./,) .
Agreement:
The,undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions okfTITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
Zp/ti unttil/a r fic.4, of pliance has beent issued fby the board-of health. J
--�'" Signed..................................
G t..' .(�_.( � ---------. l........................
` Date
Appli6at'. ppro ed By..`"r,� ."'"" f ` --. 1 - .d .
� T � Date
Ap 1, ton Disapproved for the following reasons--------------------------------------------------------------••-------------•---------------•-
-•..........................••--------------•-----•---•------•-••--------••••----•--•------•-•------•••--•-_...._....----------•-------------------......•................................•------------
Date
Permit ----------------- Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF...........>.....................,..J....... ...... k.r.....................
01rdifirtt#r of TnntpliFatta
THIS IS)TO CER IFY --,That the Individual Sewage Disposal System constructed (v`) or Repaired ( )
u�_�� I
by --•--.--- -�('-- - --•--I.... , - l 1 L ---------- ....... ............ .............................
Installer
at..................4 -----•--•-
has been installed in accordance with the provisions of TITLE �5 f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No�``.__..._.16.h.......
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL JFUNCYION SATISFACTORY.
DATE........... .: ?`'........................................ Inspector........1 ................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF/ HEALTH f
No�� Tcxbn OF.............. S •C. . .:� �?..J ._1::�? ..
.-----•-•-......../� AF ••-
Disposal Works Tnnntr Wn rrntit
g rJ _� 1� )
Permission is herebyranted................`._.._.... _: �'t-� �~
u --------------=------------- ------
to Construct.(V) or ,Repair ) an Individual.S age Disposal S stem 1 ,
at No. 1. �......_..- _j.C%� .._......:�.�. ..:......
...._�__(._...., r. ......................
Street
as shown on the application for Disposal Works Construction Permit N065_� 14.. Dat d.._<. ...R -_,-,,.,
n - s.e.-!�-►-�..,..------ ................
oard of Health
DATE ...................................
FORM 1255 A. M. SULKIN, INC., BOSTON
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MORSE
No. 10951
{��y F;1•�+`�, r � ��_ �)ta�I to \`{1. . 0 4y��, ��
r^ LEGEND
s 'EXISTING $SPOT ELEVATION. Ox0 CERTIFIED PLOT PLAN
F* EXISTING CONTOUR --- 0
� ifINISNED SPOT ELEVATION Lv � i�� rya' r� z_, � CRt�GKE2 cT
-
4{�• PINISNE® CONTOUR 0 y
NOTE The .location of any•, exsting` +underQround sewerage,
;wells; or..-`other utilities shown. on this .plan is approx- I N
<� imate".only as determined. from':records and/or verbal ��, -rA Z, A S.
information ,The 'cont,ractor xs`'responsible for the _
s>�°verification .of°tithe'.~existing `locations. .in :the field. SCALES / �t= Or DATE 1 U 2/ -s
a ",q 'DREDGE ENG/NEER/NQ CO. IMPCLIENT. I CERTIFY THAT THE PROPOSED ,
E®LSTERE RE01'TEREd 4 JOB NO. Sl2 . BUILDING SHOWN ON THIS PLAN
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CI
m � LAND-'y _= DR.BY CONFORMS TO THE ZONING LAWS
A --- OF 13ARNSTADL MASS.
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'71 MAIN STREET'' , ON, 9Y� I�AAT
��N�f'ANN.I S�, lABS. ,xy;r' SHEET.. OF E REG. LA OD SURVEYOR ,
PT.A"
2G FT M/N• /1lOTF /F E/TNER T/aE SEOT/C TANK OR �',
�• Ei�Cs//ivG P/T ARE MORE TNA:`J /2"BELO.W;
/O fT M/N r.RAOE� 24�O/AM ET.ER CONCRETE CONES q. i
SVALL BE BROUGHT TO 4rgADE.6-,N EXTRA
CONCRCTE 4/PYC P/PL 1/Er4VY CAST /RO/Y COVER S,,Y, - C3E USED
M/_N. P/TCN /F/N DRIVIFWA Y
COVERS /B PF.Q FT
2 . MiN. CONCRETE
A .° i _ G .4oE CO YER CLEAN .SANG
UQU/D LEVEL ,r
• r: z
F 2'LAYER
AA-CA57i ,/RON P/PE v a O P `/Ll•�-�/�r
MJN.o/7'GJ�/ l U O o_, GAL, ' o r • • • • • ► e �4' r.
%4'PE�J� SEPT/C TANKK o/ST • e • •Bay WASHED ST27NE
• . • • • • • e
64
• . • s t • •EFFECT/VG` • p �4 - I2
• e • • DEPTi/ • • • • . WA5h+ED STONE
I !3 l.p. 1 i ei � • • • • • • • • p �v PR, CASTSEFpAGE t
�~ 4 D GAL- �A s o• • • • • • • • a o P/7 OR EQU/V.
INVeR•T &LEVAT/ONS err � �� c,T/ 9 Y . . a EL., I00 o
/NYERT AT DU/LD/NG /a G,n FT c. 3 f
!Z SEE TABUL4TJON t
ILET W T.4 PT/C /VK
N I o .SFT - FT D/Al+�• {C�
OUTLET SEPT/C TANK ' Jd S': FT {
/A/LFT OJSD'R/�3//T/ON BOX T GROUND WATER TABLE
O�/TLETD/ST IB[/T/ON BOX l ,/' AFT,.. SECT/QN OF/A%lFT LFi9 N/NG' f�i7'.. 104,
U
:oFT SE1-VAGE /S'/�IO�S'A L SYSTEM T,gBLATIB1'1/
LEACH/N!s �.
SCALE DIMENS �ION T-
DES/G/d CRITERh-4 Ol.off.�Jvs/oN 8 � FT.
NUMBER OF BEDROOMS 3 DJMENS/ON Cr
GA-gdA6 oisvosA� uNlr /,�r�nrE .SOIL LOG
TOTAL ESTIMTED A 'F'L.OeV 3'3 y G.44:�/ ,SOIL TEST j*/._`SOIL TEST#2 SD/L TEST
r r
MUM8ER OP'LE`ACNJJ IW TS_ L_ ,' ELEY''�O$ d EL�Y, /��'3 ,DATE OF SOIL TFSiT
SIDE LEACHING PEfZ 0/7- Sr,R �T.. O RESULTS bV/TNESSED BY E E .Co�/L o%✓
! 3 /O �RTI I H4FVCOL4 '/BOTTOM LEACfINsPER P/T $q, ;r.
TOTAC LEACNlNG AREA Z�' SQ, FT. j vr35otZ S�l35o/L -'. FEWC01A770N RATE Ik2 7'`'`'�yM/wv/NCH
R ESERVELEACi/IJYG AREA Z•� 54 rT:
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