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L0CATIO SEWAGE PERMIT NO.
VILLAGE
INS T.A LLER'S NAME ADORE� � DEIR %OS '�Oti
ME
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142 Corporation Street
" OWN EA l$yon-nls, M=e 775-0838
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DATE PERMIT ISSUED
DAT E - COMPLIANCE ISSUED f
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THE COMMONWEALTH OF MASSACHUSETTSUBJECT TO APP77"'1.1 O
,BOAR�C OF LTFFARNSTABLE CONSE.�t'.�A N
COMMISSION
, ppliration fur Ilwpatial Works T,augtrurt' n rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at
....... sl. ....
o res ....
...... ........ ..... ............ ........ .. :.. Lot No.
te
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O ner .— )) � J- ....._......
M Installer Address
Q7i of Buildin Size Lot..........................p
..Sq. feet
U Dwelling No. of Bedrooms......................... .....Ex Expansion Attic a g— -------•-•---• p ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
0 Other,fixtures ..........
W
Design Flow............................................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.
3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.'-....................
.;
fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O
Descriptionof Soil -------•--• --•..........................•..------......--------------.........--------------...------........--••-----...----
U ....... . •--------•------------------•-------•......----•---••--.....-•---........ . .....------...............--------•-----------------------......----•....•..----.............................
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V Nat of Re _Qr-Alterations.—Answer when applicable. .__ (2��
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Agree t: e �
t The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with
the provisions of TITfiLZP 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
' J operation until a Certificate of Compliance has been issued b the board of health. s
p VU
igned
Date[
Application Approved BY . •........... ... ........................ ........... ! g .
Dat
t, Application Disapproved for t following reasons-----------------------•-.--.........------------....------.....------------..........---------.....--•••-----..
y`
�., ................:.............................•------•----•---------....---•-=--------.....-----...-----•---
1
Permit No........ ---. .-----•----....... Issued_.=.....................................................a
q- �7,5
t Date
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Ow
-73S ......... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF ALTH ,q
f. .
O F.................
P Appliration for Diipniittl Works Toulitrttrt' n Errant �
d
Application is hereby.made for: a Permit.to Construct ( ) or Repair ( an Individual Sewage_ Disposal i
System a ,,.�,�.»
............. . .. ... ...... -..... :... 1.......... ..... . .. ....................
ltonf ress ` Lot No
__!
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S Q
O ner
. .. / ��°,
a .... -----•-- ----� -• -^ ...- ..........
Installer — \e+ Address
'� a of Buildin
U TYP Size Lot-------•••--- •--...Sq.-feet
.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage. Grinder ( )
2 a. Other—Type of Building ............................ No. of persons.....______._.__,-r......... Showers ( ) — Cafeteria ( )
Other fixtures ......................................................
Design Flow.............................................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.
€ Other Distribution box ( .) `, Dosing tank( ) r
.a Percolation,Test Results Performed by..................
Date.......................................
a Test Pit No. L__ ._.,_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_.._:__.._...___._:_.
0 h •-•••-
Descriptionof Soil................... ._ -•-•......................................•.----••----••••-........
-U ............................................................................ ... .................................... ..._......._..........._ _ -
----- ------ --... ••....:'.......... . . -
U Nat of,$epaars.e , . .//� Ly
Alterations Answer when a llcable. �%- � .�
-- '
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A ee -ent. �-.
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The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with:
the provisions of. A. 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 %the board of health = y;
l 4
t Date '77-
1140 __•__
APPlicahon`Approved BY `'` y
;, Date
Application Disapproved for th following reasons:_.:.____:a
1 i _. - ______________________________ ____ ______________f.__-_______. ......................... -
S /�� � Date
n,. Permit:No •••----•--- %� Issued_......................................................_
ate
Al
G THE COMMONWEALTK OF MASSACHUSETTS
i BOARD OF .HEALTH
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...,�. ..... ,
......:. ......... ........ ••
Tprttf tratr of Toutpli trr
IS I O.`CERTIF T t the Indivi Sewage DisposalSysterii constructed ( ) or,_Repaired ( )
.by .,r. -'""
••------------
I' r Inst ller �
........ a ............. _ .____ .ti ` .._._. ___.. _.__ _ _ ......._.. .____ ...... ..__._.
N
has been installed in accor ar e with the provi is of TITLE 5 of ;_ e i-State Sanitary Code as described.in the
application for Disposal Works Construction Permit N __:.::. dated_.. ......................
ti
THE ISSUANCE .OF. THIS CERTIFICATE SHALL NOT BE CONiTRUED AS A G 4 i E THAT THE
�SYSTEMM WILL FUNCTION SATISFACTORY. m
DATE. _ '' . f Inspector. .........vl _--_ - '
THECOMMONWEALTH OF MASS HUSETTS.
BOARD F HEALT
.Z .7 ................................:.. OF...�.. '`... !'............................................ _
N UsFEE.
a - tit 1 ��40TAZt ttrt�tn uttt
Permission is hereby granted__.__.x ... "j"'___, .�
•-- ............... ... ...............................................
to Construct -er pair' at%,knfllvldua age D/*s� osal System .
sat No.•-..~ # •---• sM ///DDDsss
v -,�I
,_ as shown on.the applicatlon��for-`',posal �'t�'ork Con9Ld'Uction Permit No .- ated__: .�
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