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LOCAT10 SEWAGE PERMIT NO.
VILLAGE
INST # LLER'S NAME & ADDRESS
�G m
'lk S UILDE R OR OWNER
L
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED ZyZl��Z
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ffevs-f A-Z / 09 - 09
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME i ADDR-ESS
t-
-tolt OWNER N
z-/ "' IMC 1� 1157(Z�
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARDZ
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
Locatjg�-Add is,
Address 6167e3
T;ywpeiBuilding Size Lot_.W._6.9._Z7/..Sq. feet
Dwelling—No. of Bedrooms--- Expansion Attic Garbage Grinder (
Other—Type of Building --- No. of persons.........-3.............. Showers Cafeteria (
------------------------------
Z Other Distribution box ( ) Dosing tan gy",
Percolation Test Results. Performed .. ...... Date........... /.S"�
-------75�_?9 ...3w&.o3..... .......zl�!--- . .............. -...kk, . K
The undersigned agrees to install the aforedesc��4 al Sewage Disposal System in accordance with
the provisions of'TTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been jg'su�d by the bof)-d of/,reja�ph'
Date
Date
Date
'
No................
• ....-- •- Fss fir. '"...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARDF H Ar TH
*T_ .. ...... ..........OF.... ... ...............................
, pplira#flan for Dhipugal Works Tonatrnrtinn ramit '
Application ishereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: JJ
...... _..._.. . l L _. _.. :..y 40/dl;
...........................................................................
Locat' n- ddress
����--- --....-�,,.�..►i�:r fit!..._. _ � �.dr.':-- --��.�. ,a�l...���t.�.°'�.�`_..
)11 �wnerAddress Q
/r f Installer Address �
d Type Building Size Lot.
... . .j. .. ... .....Sq. feet
U Dwelling—No. of Bedrooms------ ----- --_-------------_-______-Expansion Attic ( ) Garbage Grinder ( )
� Other—T e of Building _.. No. of persons......... Showers — Cafeteria
Otherfixtures ...................................................................... ...............................
Design Flow................1.1.4.................gallons per person per day. Total daily flow........... ....................gallons.
9 Septic Tank—Liquid capacity/.4M _.gallons Length................ Width ------------
Diameter---------_...... De h...._..._....._.
Disposal Trench_No..................•.. Width_.._L/.......... Total Length....._......... Total leaching area .Y.........sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing to�j )
~' Percolation Test Results Performed by._..._... ? !?!�i__..> .._._ �''_?�'�_ ..___. Date___.._._.._;/�g .................
a
Test Pit No. 1...e..57...minutes per inch Depth of Test Pit...... Depth to ground water.. ................
Gt, Test Pit No. 2.__.!�3` ...minutes per inch Depth of Test Pit......4.......... Depth to ground water... ................
.......... - -- -••... ---- i
O Description of Soil.......- ,r✓
UNature of Repairs or Alterations Answwhen applicable................................................................................................
........................................ -------------------------•-------
. ... ----••• --- --------•---
Agreement: � ' / IE-. �.*2 ,. ✓ ".Z/•
The undersigned agrees to install the aforedescribed Indiv' ual Sewage Disposal System in accordance with
the provisions of T TL{p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b 'ss ed by the bo A of ea
Sagmed -een' .. -------------•-• ......... ............•--- ••---•--- ------
-
/� P. to
Application Approved BY----- t" t ,. !J �!j" •--._. .................•--- n_./,�
Application Disapproved or the following reasons-------------------
PP PP f f 9 . •--------- ...._------ ----
-----------------------------••--•--------•-•-•---••----------------------••-•---•------.................................................. --•--••-•-----..............................................
Date
PermitNo......................................................... Issued-.......................................................
Date
y{
iy
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
...... .... ' ... ..........OF....... . ti "t�r'�..,..........
(9pr#ifira of ToutpliFatta
THI S TO C RT That thet Individual Sewage Disposal System constructed ( ) or Repaired ( )
by -- ----- .c
------
p ` ,, nstaller
has been installed in accordance with t provisions of TITd j of The State Sanitary C de s des rib d in the
application for Disposal Works Construction Permit No._-.�,,�... _4.^�__....... dated-..-------`�.9..��...............
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......-. .................................... Inspector---- .._.._.. ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
... ....... ...OF....... ................._.._...:...........................
� !a
No......................... FEE..........................
trn Wn Vrrufit
Permission is ereby granted...... -- .....
''...
to Cons rue t ( ) or/l it (. ) a ctia Se age D psal Sys /� , l�
�t!/ .................at
at No. , ... r ' ...
Z �J.
----- --- ------------------------------------
Street
as shown on the application for Disposal Forks Construction,,P mit /_��....._;'�_. Dated.__1> `�
(' Board of Health s
DATE ... -•------------------------•-•-•---...--------•---------.......
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS f -
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FLim
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I� 1......... ...................OF....�' ......... .................................................
AVV iratiun for Diipuiittl Works Tonstrnrtiun Vamit
Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal
System at:
6z.7f.. �;...®t1 Z�?.... eS - sole
Location Address or Lot No.
o Y ..... ��R..... ..................... '.. H.... D_.� r . �htt.---
nerA dress
a "t'... .................................•---...... ► ...._ .. ........ �t.R ��.i---........
Installer Address ` l
d Type of Building. Size Lot..._......._�.I._..___.....Sq. fee0�0),)
Dwelling—No. of Bedrooms....A&... ...........................Expansion Attic ( ) Garbage Grinder (11A1
PL4 Other—Type of Building .....NA................ No. of persons........_._................. Showers Cafeteria f�)
P4Other fixtures .......................•--------------.....---••--•--.............------... .........................................................................
Q
W Design Flow............. .......................gallons per person pr day. Total dailyflow..............3 Aq..................... _Ion .
WSeptic Tank—Liquid capacity4OPR.gallons Length.Y-.�". Width.. ..... Diameter. ............ Depth._.'"... ,,
x Disposal Trench—No. ._.`. . .... Width.................... Total Length.......__........._. Total leaching area-- =::: ......sq. ft.
Seepage Pit No.........I-.--------- Diameter..... An........ Depth below inlet...... Total leaching area....�.t_sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by--........�Hp....T..��l":f... ..................... Date.....-� ..� .....
'-1 -�—
a Test Pit No. I.�C� Minutes per inch Depth of est Pit....../.�....... Depth to ground water............../ .
44 Test Pit No. 2.h5.5 .minutes per inch Depth of Test Pit....... . y-!-. Depth.to ground water........................
------ ...................... ..................�*-a of Soil...k`3_-3_.s�-- ]®�.-4'.S lib a ^
----------- ----------
U -----------------------------------34-1!......� No_ C/��----.......................-----------------�T...._j`�..... v �iFn trxi
W --------------- ------------- �`f C—/�T Sa�D �cf- !8-� . � .. E�.•S ....
U Nature of Repairs o Alterations—�nswer when ap licable.....N............................................ ......................................
4e� .f?_....... ...... _... .-----..... ................................................................................
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.
oo
S' ned---- -- ��/is, -�-k.. " }e` 0............................ ...��. .. .3.........
at
Application Approved By----.--- j_... .. .. .. ... -••-•..............................• •..--.....�,.......
D e
Application Disapproved for the following reason :------------•------------------•----•--------------.......----•-------------•---•----.....:..
-••--•--•-•---•--------------------------••-------•-----......------••.......•---•-•••-••-••---•-•---.-•-
Date
PermitNo......................................................... Issued.......................................................
Date
-- -- - - - - - - --- - --
No.� .._... �� Fxs..............................
TAE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.-.....4................OF... h1 c ......_....•..............
Alip iration for Diupuual Workii Tonstrurtiurt Prrmit
Application is hereby made for a Permit to Construct (;e-) or Repair ( ) an Individual Sewage Disposal
System at:
... ... .. .---
Lo atoon-Address or Lot No.
------------------------------------•----. ............................................
C Owner Ad ress
W o �T �c12
Installer Address 3i '^
d Type of Building Size Lot...... i___v__ .......Sq. feet
U g— __.._Expansion Attic (--� Garbage Grinder
Dwelling No. of Bedrooms._._.__��__________________________ ag
p,I Other—Type of Building ...........A_ No. of persons.......... __.___...._.___ Showers ( ! ) Cafeteria (-?'
Q' Other fixtures _________ ___________________ _
W Design Flow____._..._._5J________________________gallons per person per day. Total daily flow........33_�.__._.____.._._____.__._.gallons.
WSeptic Tank—Liquid capacity. + ._gallons Length_._g^6.`�.. Width._. '6 Diameter________ ______ Depth_ "�6_��...
Disposal Trench—No._.__.__. ...... Width____________________ Total Length.._._-:____-____.___ Total leaching area_. .....sq. ft.
x Seepage Pit No--------,----------- Diameter.......b�..... Depth below inlet..._._..`........... Total leaching area... ....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by........... RT C i ��
�`' 1 Date......
1 Test Pit No. 1_.L--- ._..minutes per inch Depth of Test pit....../S ...... Depth to ground water........ .............
Li, Test Pit No. 2..`: `-___._minutes per inch Depth of Test Pit...... ..__ Depth to ground water....... 5._-_.
Ri .0 ! - _• .__A.A�Ms b�--5Lu1bA 4a- .........................................................
o4M t J6
r . ..__
O Description of Soil--•••----•----•-•-•••- a Y a q- /V SgNO-c/qY M IXTVR�
V .................................•-----•-•••••-••••••Z..•- ...�..._....T/Et(f.S�D..._...-••--•••••--•••••••••-••..._1:7--•_)g•& CICA. MAD.SR•
UW ------•---•------- --------------••••-••-------------� -�-------- •----•--••------•---•--...__-------•-••--••--••-----•-•----•-••---•___...--•-----•-•-••-•------•--•
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 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- pp a 3
Application Approved By______________ l__ ______.f!`./�
Application Disapproved for the following reaso •_._._..
-•-•-----•-----•••-•--•-•--••----•-----•-•-•---•••--------------••••••••--•--••-•••-......_..__...---_----
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. ..........................OF...................,.. .......
i��rrfif�r�tr ,af ia�t�rlt�tnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) oeR/epaired ( )
by-••--•••-.....`.tomb r.,•V......
_... Installer------•--•---------------------------- ......................
...............•^ --••---at
j t
1 �� ( ... c E l - --:-------•---4
has been insta11eY1 i acco�ance wi h the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nq:!F?- ___ _______________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B.E __CONSTRUED AS A GUARANTEE THAT THE
,.--
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................•-------•-----....------.....-------....._•---.._..._...._..--_. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
9 {r--bk-e- r
(.��. .y�.......OF......................aL!��1 S `
FEE..� ..........
�tu�ruu�tl Turku �ua�u#r�tUan �rrutt�
Permission is hereby granted .........
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ,' -
at No._••••-----•-••--_--. -} tee- L (-"A �CM (\S t�k��e�
•O�G�. ` \ �F•�.r1 - - --._...-•-Street................................................................................
as shown on the I3pli tion for Disposal "I s Construction Permit No..................... Dated..........................................
f
r- -•:/ lj .__._-------•--••-•------•-•------••---•---•--••-
Board of Health
DATE........................................
FORM 1255 A. M. SULKIN, INC., BOSTON
NEI !Gc /err+ S V t n�
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L EMEND L T 70 �/ACANT kO�sE ow w.
EXISTING SPOT ELEVATION. , x0•. ���N OF IS
3 CE IFIED PLOT PLAN
EXISTING. CONTOUR �' �
t i ROBE6iT s G.U 7 r ?.$r
FINISHED SPOT ELEVATION
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APPROVED BOARD OF ; HEAL,TNY� r
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DATE AGENT v " ;, ;° Eq '` P `{i ' SCALES' 1r��4 DATES `I;�3 v "
LpRfpGE ENGtAIEERl16IG CGl IN Y `
CLIENT _" �.. l t`CERTIFY THAT THE PROPOSED-
EGISTERE REG18TE-RED4` ` ` ' BULLDIPIQ SHOWN ON .THIS PLAN'
= JO8 N0.,
CIVLL LANDi CONFORMS TO THE ZONING LAW i
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