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ELLEY !j
No.26160_a v, - CS;27/Gy 1Mg7' Tly� P.�b sty
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LOCATION SEWAGE'. PERMIT NO.
lCrT 92 4-t"q - a�i5
VILLAGE at7
_D-9
INSTA LLER'S NAME A ADDRESS
_ a. � ` �
�8UILDEIt OR OWNER
O h
DATE PERMIT ISSUED �aO -�rq
DATE COMPLIANCE ISSUED � Z /
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37. S
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No.........:.......... a ; Fxs..... .................
THE�VCOMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............%W�1/`_........OF...... / GL—.. ................................•-
Appliration for Diopoiitt1 Works Tomaxurtion .erutit
Application is hereby made for a Permit to Construct (L--) or Repair ( ) an Individual Sewage Disposal
System at:
g: f Q,q �sT1�1�3 ............. Gc'
Location-Address or Lot No.
-�/Z�9't6 �i�z. OlGo/�/�...-•--•---•-••---•-•....... ....... Y,a�w.S /j/ S................................
w z Address
Installer Address
d Type of Building Size Lot-4-3_,'-F5¢._......Sq. feet f
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'k Other—Type T e of Building __.._.___. No. of ersons____________________________ Showers
Aa YP g ---------•-•-•-•-- P ( ) — Cafeteria ( )
G" Other fixtures ...................••--••------- .
W Design Flow................-537 .__.._._.____.....gallons per person per day. Total daily flow._.___.__.33�.•.__...._:___........gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal !¢ g __________________ Total leaching area....................sq. ft.
Seepage Pit e1Nol......... .__----- Diameter idth.....�__._.. Dept obelowtal ninlet._. Total leaching area_-3!Z:.g...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.....%27-' a^�..._.11........ �. /. Date... ....�7
�l �� 1............... f-------•-•-•---
,-a Test Pit No. 1.. ._Z__.minutes per inch Depth of Test Pit-� _ .....
Depth to ground water..-__--_._.__._....
(i, Test Pit No. 2.L. -_._minutes per inch Depth of Test Pit.... 8D....... Depth to ground water_.•_____—.__.__.••...
-----------------------•-----.......---.............._.......__............_._...................---......................................
•.......
-..........
O Description of Soil......... `_____ !7 ? ....: �✓� T?.......................................................
---...Bo " o`IGD=-•-SAwD ...................... -•_-•--•--•.............................•-•--•------------
W
-------------------------------------------------•-------....--------------------•------•-•------....._..-----------•-------•-•----••...•----------...---•••-----•-••---------.._..--•--------•-_-••---
U 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 iITLE 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.... ......�cA1�•% n�
Application Approved By...................
bate
Application Disapproved for the following reasons:....................................•.,...._._......._..-_-___•__-___-_---______•_______._...__.....__....._....
.................•--------_..._._....----•....-..._•--------_....._......--••----•-••-•-......-----•__•-----•-•--........_.._.._...._._...._.._..-•----•--•---•••-•---•-----------......--••-----•_...•-
Date
PermitNo......................................................... Issued_.......................................................
Date
No..S.G,. Fres..... .................
THE'x OMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............
...........OF....... iz-neST.saG .'.....
Xpliliratiou for Bhip ial Workii Tontitrurtion ramit
Application is hereby made for a Permit to Construct (4, ,) or Repair ( ) an Individual Sewage Disposal
System at:
...... -- ......--••••-- --_. . -
Location Address. or Lot No.
P�7� /�1?2,t?f /!emu / ter/ .,K S.S
......... ............•..f-•- ......--�---•--......•••................... .......... '!� ... .............:. ._.........---.....
wn r -r Address
w . .1 .
Installer °d Address
QType of Building Jm Size Lot.!63._�F ........Sq. feet f
U Dwelling—No. of Bedrooms................. -a,= _....Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
-Other fixtures -•-------------------------------- --------••-•-••-------•----------------------•---- ---------------3----�---.....--•.................--•---
d -
w Design Flow.................�?�r_...._,____._____..gallons per;person per day. Total daily.flow.._.._.._._..._...._.._.....................gallons.
WSeptic Tank—Liquid capacit ----__--____gallons Length................ Width.......L------- Diameter................ Depth................
x
Disposal Trench—No_ ____________________ Width....?.............. Total Length........="........ Total leaching area....................sq. ft.
Seepage Pit No_....../.......... Diameter.-___4........ Depth below inlet... aS...... Total leaching area.4v7..H...sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.._._oS =�' !.._��=.._ !� �...2c_5.�___ Date... .....2?- ���3
................
aTest Pit No. 1.. _. -_..minutes per inch Depth of Test Pit.• `4....._......... Depth to ground water...._..^"":............
44 Test Pit No. 2.: :.2----minutes per inch Depth of Test Pit..__�S'a Depth to ground water........"'...............
-----------------------------------••-•----•-••---------------.......--•-------•------------•--...................I
Description of Soil......... `f . 5;ke��Pe TG.n.•• .S r•/? �!✓..Tt/ `�/,/
/�.'_ .. ...!_...._ __... .........."".y�.. ..........................................................................:............................................
U
W
U 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 TIT11- 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...................................................................................... .
Date
Application Approved By.............. ..._ .--•..................................... . �-•-•----_-
te
Application Disapproved for the following reasons:...............................................................................................................
..............•----....-------------------•---------------------•--•-••--••---•---------...__._........••'--------------•-------------•--------•---=---------•---------....-•----------------......._._..
Date
PermitNo......................................................... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ .laN...........OF......4 .. ....N..,;-S�T...�''g ......................................
Trrtif iratr of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
bY....................................................................................................................................................................................................
�, Q f- e, e�4 4- 111/d.( 'id, Installer � lzelx '
at .............•------------•--...---------------------•----------•------•------.-----•---so-- ......-----------------------------•.........---------••------•-•-•••••----.._.....
has been installed in accordance with the provisions of TIT I_ j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No............. ......... dated..... .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE
SYSTEM W.ZvFUN )(O N SATISFACTORY.
•-•••...............DATE._.... . Inspector
r a ,
THEE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................oF..............................-----
j FEE...
Difyoottl Workii Tonstration rrutit
Permissionis hereby granted--- -------------------•-------...------•--.---....----------••--------•-------•-•••----------------•----.....----•----...........---......
to Construct (tom or Repair ) an Individual Sewage Disposal S tem
at No........ �-�n Al.
....-.•....-•-----•.....ic.c
Street ell y ✓� � � -i
as shown on the application for!Disposal Works Construction Permit No____________________ Dated....... ._.........__.
'k - _ - --•--------------------
Board of Health
DATE..........=�---�--`-'-.`:. ..•--•-
r
FORM 1255 A. M. SULKIN, INC., BOSTON
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TOP OF FOUNDATION
;�� CONCRETE COVER
:,. CONCRETE COVERS
e 4' CAST IRON (2"MAX. � r
PIPE (OR 12"MAX.
EQUIV.)— MIN. 4 ORANGEBURG(OR EQUIV.)
• PITCH 1/4"PER. PIPE- MIN. LEACH
PITCH 1/4"PER.FT. PIT
°•'° PRECAST
NVERT a LEACHING
EL•.84. •• INVERT INVERT p . ; PIT OR
e'.. SEPTIC TANK DIST. EL.....•..r3 > ,�:INVERT EL.•8 i z BOX AT8 .W xy 1i:, EQUIV.
GAL. INVERT
EL86,00 INVERT wWM0po: 3/401TO11/2
ELio WASHED
w STONE
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6 DIA.. —►-I Ne
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PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
f�-Z733
SOIL LOG WITNESSED BY :
DATE Dom. z7/983 TIME /o:oo q/y, BOARD OF HEALTH
.01
TEST HOLE 1 TEST HOLE 2 s �0,� .�. y �-S: ENGINEER
ELEV. . BG.,/0. . . . ELEV. A7:3P. . .
�� coy 7-bD DESIGN DATA :
W,r7v w�nv NUMBER OF BEDROOMS
jr/NC'3 TOTAL ESTIMATED FLOW ,'33�, GALLONS/DAY
/Zo" eL-77 3 0' /.�3
BOTTOM LEACHING AREA Q.9. , SO.FT. /PITIC.F?D.
�jZ ` / Q' 7'i" SIDE LEACHING AREA : . .�J�3.1, , , , SO.FT./ PIT1386-C.P.D.
Fin�t A GARBAGE DISPOSAL . !V - . .(50% AREA INCREASE)
R•r/D O
TOTAL LEACHING AREA . .307 S , SO.FT
Z04!'I z9./0 Mot/ 47Z,=7z•3o PERCOLATION RATE 16E3S ?� ! .7'y�/o MIN/INCH
.WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE *'?-.`J SQ.FT/_;PP.
NUMBER OF LEACHING PITS
APPROVED . .. . . . . . . . . . BOARD OF HEALTH . . . . . . . .
DATE . . . . . . . . . . . . . . . . . . . . . . . . .
I AGENT OR INSPECTOR
9 OF�fgSJ
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