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ASSESSOR'S MAP N0. PARCEL
LOCATIONS-- 2"{ ` SEWAGE PERMIT NO.
Ze-'7 y eJ11U e elite
VILLAGE
I N S T A LLER'S NAME i ADDRESS
lo�i� R OR OWNER
DATE PERMIT ISSUED .
DAT E COMPLIANCE ISSUED % <��
N
/4t
1 _
0 � � -
No.S .'- .18
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ..............OF..... �s !9" GC......
Appliration for Uhipasal Workii Tonstrnr#ion rrntit
Application is hereby made for a Permit to Construct (tom or Repair ( ) an Individual Sewage Disposal
System at:
�WS>L�BG
......Xi __....... ........�... .. ----•-•-----••----------•.........---•-----.....--••--•-----......•-•-•-...........---••--••..-•--
L c ;ion-Address or Lot No.
/�-r� D�ivis�T: z 1i�................., i® �,,��l T................................
_......... ...... c.
Ow Address
W
ns a e Address
Type of Building Size Lot..........................Sq. feet _
U Dwelling—No. of Bedrooms...................1�......._...._........Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ................................. .
W Design Flow................... ..................gallons per person per day. Total daily flow..............
� Septic Tank—Liquid capacity.�S®..gallons Length.. 16`�... Width._44,1
`�`�`�... Diameter................ Depth S'8°'
Disposal Trench—No. ....... ........... Width....... __ _.__ Total Length.....7z........ Total leaching area...-!?.Z....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---APW297-�....�..._'e u ............... Date_��`-`$:...'.�.�g `__....
,aa Test Pit No. 1....L.Z%...minutes per inch Depth of Test Pit..... .Z_". Depth to ground water..... .............
Test Pit No. 2...4..Z_..minutes per inch Depth of Test Pit...... Depth to ground water........................
P+ •-••----•----•------•---•---••••.................................................•-•-••-----.............•---••---•••••--•-•............__........------.....
O Description of Soil.........a_ : Z¢".....Woc1�La/�rt .Sc�6-Sa>[. Z¢"__/3 Z Cti `S
--------------------------
W •-•-•-----•-------•-•------•------••---•-•--•-•••••---•----------•••--••--•------------•..............•-------•-•. •-••--•-•-----•----•-••••--------•-•--........-••••..................................
UNature 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 LITIS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i slued by the board of health.
Signed__ .....•• -
/�._....'.. ................................. ...._.............
Application Approved By..................... ........ t................
Date
Application Disapproved for the following reasons:..............................................................................................................-
---•...............••---••--•----.................•----•---.....-•-......-•••-•--•---..........._..-•--•----•-•............._..---•-------•--•--•.....••-•-•----•----•-----•---••---•-•••-----••••-••---
Date
Permit No.......... ..... � Issued.......................................................
Date
in.
No.., !fl Fs$...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... .//./d....f..............O F......'.f�?1_772>':1.-5 Tim}/_5
AVVliratiun for UhiV sal Works Tonstrartiun "rruti#
Application is hereby made for a Permit to Construct (i_. or Repair ( ) an Individual Sewage Disposal
System at:
....W/-/i 3 rZ G� rz! i2. ... � Z�......,,; /`l iG.c_s .... -.. .....-• .........................
..._...----
Loc lion-Address
or Lot No.
.................
Owner Address
.....•... ..t E'er -
, F
ns a e Address 4V �/
Type of Building al Size Lot.. 5..................Sq. feet
Dwelling
U No. of Bedrooms..................4...... __ .Ex Expansion Attic
a — ----------- p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures ------ -•--------•.............•---------------------......--••---------•--------------------------------•-••--------------•-••-••-......--...........
w Design Flow................... s _-----.---_--.gallons per person per day. Total daily flow---........•...4�0..................gallons.
WSeptic Tank—Liquid capacity-/S(�e.gallons Length-.a., ../_.. Width...` �G-�... Diameter................ Depth................
x Disposal Trench—No........ ........... Width....... z..f..... Total Length......3.Z........ Total leaching area.........:L....sq. ft.
Seepage Pit No---------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
4 Percolation Test Results Performed by.........:..?.^........:.>......._._ .............;!................ Date-.&�-_�s..�1��._...
4 Test Pit No. I....!�..`....minutes per inch Depth of Test Pit...... Depth to ground water........
fsI Test Pit No. 2....6 ___-_z...minutes per inch Depth of Test Pit...... '��.. Depth to ground water........! .........
---•-------------------------------------•-------........--•-----••-----.........--•-----------.......----..................--------............-•••----••--.
O G"- C4 " woo i��/a-. as S�tj-so,,G. �'"� ✓,3Z" rc.,� %.se--
Description of Soil ................•.....•..--------•----•--••-------•------------•-------•-•------------------------=----•---......--•-•----------...------ .......---........
V ,1.. .:..::�-------------
...--------•--------------------------••----..•.......
w
UNature 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 of health.
Signed....................................................
'-
,���rr ..............•-.
r t. t
APPlication Approved BY � ... -: .... o
.. rt
Date
Application Disapproved for the following reasons------------------•---................-------------•----•---•------------•---------•••......----•.........------
.................••---••-•---••-•.........•-•---•-------••----•-...........-----•---•--•-••-•--•----•-•------•..........-----•-----••-•---•-••--•-•-•-••---...---•----•-...-•••------•••-•----••••......
Permit No.........r-Z�•.aM�.'.....: ` L � Date
'�
.._...--•--•------- ------- Issued---------------- --•---•--•---•--------•-•--....__
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
%�....../.........OF........� /'}.x�i�!'S
..............................................................
(Irrtif iratr of Tuntpliattre
THIS IS TO That the Individual Sewage Disposal System constructed (roe)—or Repaired ( )
F AF
by.. . . --••-----
v staller
at
has been installed in accordance with the provis� of TITLE 5 of_ he State Sanitary Code Za des ribed in the
application for Disposal Works Construction Permit ivTo.._ o.M.___--p ... dated..........-j .f.f__�'�a..............
THE ISSUJ CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARNTEE THAT THE
SYSTEM VTION SATISFACTORY.
DATE....._ V..... ............................................ I Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
72'1111n...........0F.......... /f7�.Jt/sTi�:3G . ...............
f 1 ............
No..... ............. FEE---..::..... ......
Disposal Works Tuns#rur#iun "prruti#
Permissionis hereby granted._�7- .- ...--•-••--.---•----•..............••----•----...............-----.......................-----.........._..
to Construct ( --r orr Repair an.n. Ind vlya/lSwia Disposal tem
�.L.. .. ........^_.�YY
at No � ..... ......:. � ,✓ -- .........+t........................ ...........................
Street
as shown on the application for Disposal Works Construction Permit No.S2�_'8'eDated.......f V ................
�•�.` �` .........................��..---......_.__........._____...._._.......____..........
/ r' Board of Health
DATE....' J I`7. GJ. ' _
FORM 1255 A. M. SULKIN, INC., BOSTON .
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z -'HENS
LOCATION
. . . . . ... .. . .. ... ...
SCALE DATE !r?!
PLAN REFERENCE
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`EAARDE.
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ELLEY
o. 26100
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100,
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Ae7777111e71-' E"
-SN��T Z oc L SN��TS
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TOP OF FOUNDATION
CONCRETE COVER
T CONCRETE COVERS
V7"77n7r
Z e 4' CAST IRON 2"MAX.
OR SCHEDULE 48 12"MAX. '
P.V.C. PIPE 4°SCHEDULE 40 PV.C.(ONLY)
PITCH 1/4"PER.FT PIPE - MIN. ZL �,4U,,
PITCH 1/4"PER.FT. 7NGN
PRECAST
e' INVERT Flow-
,,6 5
:. DiFFuso e EL..fS38. INVERT DIST. INVERT P . 12 4:� 3
SEPTIC TANK EL-44. . EL. s:(. F4w- ,°: �e INVERT /Soo ' „
GAL. INVERT BOX
EL..'fSLo.,. " " " `8 EL INVERT 3/4:.►. T01Ili'
EL.4f�3P WASHED
STONE
7-41
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. • 32 '
PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM Se N aI7 �
NO SCALE ' cVbZ
f- 7G 4
SOIL LOG WITNESSED BY :
DATE73. i/iSBG TIME. . BOARD OF HEALTH
TEST HOLE 1 TEST HOLE 2 /Cc�ZGE)/ .ENGINEER
ELEV. .¢7 40 . . . ELEV. .�':7a. . .
Im
DESIGN DATA :
tz,¢S,4Lo SvS-so/L
aa"
&Z 39 zo NUMBER OF BEDROOMS . . .��. •� , , ,
CaA7ZSL � � TOTAL ESTIMATED FLOWb, , GALLONS/DAY
s, >
� 38¢
w/ $ BOTTOM LEACHING AREA S0.FT. /PI TIC RD.
rr �i 2ih'E`Z- �8
L4yex-s 919 SIDE LEACHING AREA . . . . . . . . . . . SQ.FT./ PIT
zzo C;P,D,
6lISW�Z �s5� GARBAGE DISPOSAL .NoN . ,(50 % AREA INCREASE)
s$D TOTAL LEACHING AREA . . 7z. , . SQ.FT
/3Zr EL. 3C,4, /zo" �'Z, .32,7a PERCOLATION RATE . . C�S. �/P MIN/INCH
*�. .WATER ENCOUNTERED rZ1sr Afle-E "Z
LEACHING AREA PER PERCOLATION RATE .lvb¢.. SQ.FT./CP,D
NUMBER OF LEACHING PITS
APPROVED . . . . . . . . . . . BOARD OF HEALTH �i�Fti5o2S �/ift( �ar✓2 �- O�
DATE . . .
AGENT OR INSPECTOR
` r a�P�SH OF &fqS Q
loT � EDP^R R.
LL�LEY N 7
:7� /!/�� No. 26100
GISTEF��O� ` SaNRABtA�
PETITIONER /�'VAL
�! i l { rl 1 1 I:IIr.�:C r '..... __ _••—11 i ! ' _....—....-� „_�� i
. . Camp 1 e 1 cd by --- --
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location:_ `V4-/_S Lot No. Zo
Owner: Wiel-1, Hoe, Address: z,7-,x./ 22>iZ7-
Contractor: Address:
Notes:
STEP 1 Measure- depth to water table
to nearest 1/10 ft. . . . . . . . . Z- /BG 8• o
date
STEP 2 Using Water-Level Range Zone
and Index We 1 Nap locate .
site and determine:
A) Appropriate A ro riate index well . SDW _ZS3 .
B) Water-level range zone .Zo.vcr. 3 . , 2-3 F7-
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to
water level for index well . . . . . . 2-/86
mo yr
n
STEP 4 ' Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water-level
zone (STEP 2B) determine l �
water-level adjustment . . . . . . . . .. . . ... . . . . . . . . . . . . . . . . . . . . . . . . .
STEP S Estinate depth to high water
by subtracting the water-
. love) adjustment (STEP
_ 4)
from measured depth to water 3,
level at site (STEP 1) . . . . . . . . . . . . . ... . . . . . . . . . . . . _ . . . . . . . .
figure 3
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LDCATION , /`!!a?esTa•vs. . . .�?/GGS, ..
SCALE . DATE ! ?p!G 3/53` �ssu�s�-D D•rw.-!.
PLAN HEFERENCE ...,00e,?gG .zor*Z.9 .
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