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FLOOR PLAN 75 VALLEY BROOK ROAD
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BATH
BED ROOM
KITCHEN DINING ROOM
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Bad ROOM
BATH
LIVING ROOM
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LOCATION. SEWAGE PERMIT NO`•
VILLAGE
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I N S T A LLER'S NAME A ADDRESS
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S U I L D E R OR OWNER
DATE PERMIT ISSUED y
DATE COMPLIANCE ISSUED
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L0CAT10N. a SEWAGE PERMIT NO.
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VILLAGE
INSTA LLER'S NAME i ADDRESS
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• U I L D E R OR/,OWNER
DATE PERMIT ISSUED !
DATE COM ►LIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
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Appliration for Uiipniittl Workii Tomitrnrtion Vrruti't
Application is hereby made for a Permit to Construct (L-<Or Repair ( ) an Individual Sewage Disposal
System a �
.. ... . A. ......91.�:......C�n �----------•-------..... :--N......................................................
Location Address or t No.
Sm.:,....- ......... ............................................... ......__ �. .. .. .......... ....... ................
Owner Addre s
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a ......... ... .\.. t._l ....��__....._ T_..._.........._ ..........__.._.. ._U` ...J(�..aP.... ..._......._......._
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................
................Expansion Attic (�.9)® Garbage Grinder
PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures .............................................................
W Design Flow............... ...................gallons per person per day. Total daily flow............ 3..........._..........gallons.
WSeptic Tank—Liquid capacitX00 O.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.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------•-. ` .................................................................
O Description of Soil.. '. .e"� �� \�
V •-•----•-•-------------•----- ... '..••-•_... ----- ..........a.........S J........;;� ----------------------•--•----__------
W - f?n_ ... -- - rl--- �G
VNature 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 TITLE 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 off health.
Sig
Application Approved/By-- - ....�...............••-------...-•-------•---••-•-------.._....-•--••----•-•------- --•.. DeDate.Application Disapprovfollowing reasons:-------•----•----•......................................................•------•----------...---------•--......
--------------
•--------------
••--•-----••-------••----------•-•--------------------------_---
Date
PermitNo.......................................................- Issued_................................... --•-•-------....
Date
-t,
N0.1ty. j, FRic ....................
THE COMMONWEALTH OF MASSACHUSETTS
s
BOARD OF HEALTH
.c .t• ..n...........OF............B..'�.�..�1--- n..�,-.. .. ... .......,
Appliratiun for BiupuuFal Works Tonutrurtiun rranit
Application is hereby made for a Permit to Construct (�o�r Repair ( ) an Individual Sewage Disposal
System a :
!-...... t^r ................. .............................................................
Location-Address or Lot No.
rrn.:a... ..�,. .,.. ............................
Owner Addre s
a .. ................ �_ _ 5..... -...---_�. : G-..
Installer Address
dType of Building Size Lot________________ q. feet
U Dwelling—No. of Bedrooms........... ..........................Expansion Attic (P)opGarbage Grinder
U
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................................. .
W Design Flow................&Q...................gallons per person per day. Total daily flow............S2... ?_.................gallons.
WSeptic Tank—Liquid*capaciARO:�_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.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ----- ..._..-•••-----•--•....--••-•...........................•-•--
O
Description of So>l "" a'."__ �� � _.___.._.
U ................................� in - ? Ce. ;^*.------•--�-•--------- `'��' 'a .1..-i
T -------------
W ----••-----•. 5..••.--X--�--------- ��!'�
VNature 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 LITLL 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.
Sign ✓hl ' ........................... L"'
...1 Da
Application,ApprovedZ.... r-•..........-••---•-•-------•--••--•--•..........-••-•-•--•-•--_----•- •---. a� � - •--•---
Date
Application Disapprovwing reasons-------------•----•-----------------------------------•----------------------....--•-----._..----•--•----•-----
--------------------------------------------------------------------------------•--...-------------.....------•--.._........----•----__.-------------------- ...........................................
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALtH
Trrtifiratr of Tomplinurr t'
THIS L4 TO CERTIFY, That the Individual Sewage Disposal System constructed (L,4k or Repaired ( )
_. ..................................................
Installer ` ,�
at... 1�- �►. _.. ---•-- ---- ca.-1 - - -�.•--- �«4.,.�.R:..n-- ..................
has been installed in accordance with the provisions o ITLE 5 ofT� State Sanitary C as cr•bed in the
application for Disposal Works Construction Permit No.___ _r..._y _ ____.___. dated_.��� __________________________
THE ISSUANCE F THIS CERTIFICATE SHALL NOT BE CONSTRUE 3 A GUARANTEE THAT THE
SYSTEM �dVl FU TION SATISFACTORY.
DATE__.. __.�. .. Inspector._..._ .._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................
.OF..................................................................................... v
_...... FEE Y..................
iuuutt ku Tunutrnrtiun �rrntit
Permissionis hereby granted---••------ �-------------•---------------------------------------------------......------........._...............
to Construe Repa� ),� I divid I Sewage Disposal System
at I �--•---- q
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Street �j
as shown o/the plica n for D• posal Works Construction Permit No_____________________ Date _ ._.Y........._..._._...................................•-•-----•---•-------•- ---•--- •-----....•--------...-•----••--••-•...._.._Boa of alth
DATE �r --•---------.•.---•-•-----•-••-•------------------
FORM 1255 A. M. SULKIN, INC., BOSTON
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s PLAN PHONE50&420-1290
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Air txahan®rr
110 d875AT'
Oared opening 92"xLl2"
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• Strip existing dry wall / insulation
• 'Paint Foundation w/ U64L Dry LoK
• Frame per plan: 2x4 KD 1W oc w/ pt
bottom plate
• 2xio on walls with lallys _ �4 a
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• Strap ceiling except bath room FAMI LV MOM
UNFINISHED AREA
• %:" plywood risers on existing steps
• Insulate walls RI3 fiberglass with tyveK to OFFICE rinishad tiling I lieght 85"
cover exposed in unfinished area
• %:" MR t5oard on all walls fir ceiling •-{r f-
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3" colonial base FURNACE
• 2 % colonial casings 1
Ceramic Tile on all floors in finished area
• Cover Ceiling in unfinished area A with I ROD 2"
%Z" foam board
• build 7-v4 VT base with I/2plywood top
for shower I
Beth Roogr RM 32 x32 r i
na alrapping on ceiling I I Heil vtial,&
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mine efiurrbi 8'fbi dvahi I
98.0003 ny.IL TQ'l ROOM
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UNFINI SHED AREA
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Cured uperiinj7 PPD 37"ICK7"
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' ohcn residence
= > 199 Elarneslnble Rosin
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