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LOCAT ION 5 AGE PERMIT NO.
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VILLAGE
Lam. vy1 A v vt�'
I N S T A LLER'S N✓rAME i. tADDRESS
65, Cop S
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L
y� a UILDE R OR OWNER
AI Ll C` 6u.
DATE PERMIT ISSUED
DA,T E COMPLIANCE ISSUED ?d so
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No. -�'� - J Fss...:� ..�...........
THE COMMONWEALTH OF MASSACHUSETTS
�l BOAR® OF HEALTH
.............70A :o .........OF......��/�'!2.�1>S';. Iq C
Appliration for Disposal Works Tons rnrtion Vautit
Application is hereby made for a Permit to Construct (c-,) or Repair ( ) an Individual Sewage Disposal
System at:
.Z7!?1575. '.`/ .....�3GY�ZNSi/ l3GG ��T �
.... --•---...----- •................................
Location.Address or Lot No.
!✓,YGs._.Gro wG u- ---------•-------------------------- WL T- X/�-1 o ,,.........A:;-'`�:S S..........................
Owner Address
W _
Installer Address T
Type of Building Size Lot....T..... .................S feet
Dwelling—No. of Bedrooms.................
...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................................... .•..-_
W Design Flow........:...... ..._..._..___.___.___..gallons per person per day. Total daily flow__._...._._..._3�n..................gallons.
W Septic Tank—Liquid capacity.i�Qn..gallons Length._8.'6"-_-. Width.��L__`�__- Diameter________________ Depth. :8`...
x Disposal Trench—No. .................... Width_................... Total Length.____............... Total leaching area-___-__---•-•-•----sq. ft.
Seepage Pit No---------/�--------- Diameter..... n./....... Depth below inlet.....6 1.......... Total leaching area...�7.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by__.7P>� ..... ............. Date...��
r
,4 Test Pit No. L_z!�:... n---minutes per inch Depth of Test Pit.._e _'./ Depth to ground water...................
f= Test Pit No. 2.. .._Z...minutes per inch Depth of Test Pit____! `..•.. Depth to ground water-_____---__._.-____
•---------------------------------------------------------------•----•.-------------36"_/44" ��✓� Pnca Sao
V ......../4� -/.Yb_....... ;2r( SF N
--- ................................•------•----------••-•----•---••--••----.....
W ------------------------------------.--------------------------------------------------------------------------------------------------.------------------------------------------------------------.---
V 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 iITL U 5 of thnfollowing
itary Code—The undersigned further agrees not to place the system in
operation until a Certificatte�of Co as been issued by the��thnne��board of health.
d.- -•........ ....... y
Dat
Application Approved B .•••••. +-- _... . . ..................
Date
Application Disapproved for the easons:_....-•-•--•-• -•-----------•••--•----•••-•-•--•••••--•-----••-••----.......•••--•----••-•-----•..............
.........................................................................................................................................................................................................
��>> tt LL Date
Permit No...........?. --------- Issued............r J_-Eta-- -
Date
44
No. -................... � P FEs..�r.d...............
'cl THE COMMONWEALTH OF MASSACHUSETTS
6^1 BOAR® OF HEALTH
.....OF.....4644eA/ X!*,64E'
ApVtirFation for Uispaoai Works Tonstrnrtion Prrutit
Application is hereby made for a Permit to Construct (,`) or Repair ( ) an Individual Sewage Disposal
System at:
.. ............
Location-Address or Lot No.
/. /G6+N C ZC I!S//�+.. .... �./C/.t!U�sT?.!. ......�/!5..............................
Owner Address
W
Installer Address
Type of Building Size Lot__-4 .00........Sq. feet ;
,., Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
al Other fixtures ------------------------•--•-•-••---....---••--•-- .
W Design Flow................ .......................gallons per person per day. Total daily flow.............-��-'a____.______________gallons.
WSeptic Tank—Liquid capacity�op9___gallons Length_4_1 ......... Width.-'4.'L.`.._._. Diameter________________ Depth_:'$"'_..
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../.......... Diameter-----�p_ ........ Depth below inlet....A_____________ Total leaching area._.�G_7......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
� Percolation Test Results Performed by--- ?%!!5: : ' �� ��'/________________ Date__e9j- �•_..: _°,.1?84._.
-------------••---------
Test Pit No. LA.__3-__ minutes per inch Depth of Test Pit•-6.74`r___.___ Depth to ground water-----
(s, Test Pit No. 2_i;�___:4_-____minutes per inch Depth of Test Pit--- ........ Depth to ground water........................
___________________________..__.______:_.______._________...._________._...._____.___...`s�.........A.......__..______.__.______.._.._._____._.._._.__...._.
D Description of Soil........ "/ o i! ...r S ' -S_��G. S6----144 , 6i"4-
x ---------------------------••••--•--•_•...
U ......-/.=!/ !.`....................../r/ ................------........_.._....
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__ -�1.�_ .....- � U ¢
Application Approved BY -:f f-�"'" '- '�/..� .. .. . ............... !✓. .......--l_.---
�•""'•'`- Date
Application Disapproved for the following reasons:.............. --•...--•--••--•-•-•--•---•.._•-------••-•--------•••-•-••-•... --............-
..................................................... ................................................................................................................................1................
Date.
Permit No------- ¢ J ®. Issued_ y
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Qprrt firatr of Tuntplianrr
THIS IS TO 9TIFY, That the Individual Sewage Disposal System constructed (✓I or Repaired ( )
by----------------------
+v........--•- -------------------------- _•- ----- -------••---•-•---•--•----..........._.__.....----••--•------------
I ._ ----
r
has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as escri d in the
application for Disposal Works Construction Permit No----___.__'_�.__------- _ _____ dated_.....6� _._ {__b.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRIKE® AS A GUARA TEE HAT THE
SYSTEM WIL FUPICT ON SATISFACTORY.
DATE._...Z•-- 1_3.. • ................................... Inspector__...-- -• ....... ....... ... .................
1 THE COMMONWEALTH OF MASSACHUSETTS 4
BOARD OF HEALTH
✓`/`' /� 7fP 1r.A/.............OF
. ..... i.3a?�✓,5"�6�!,�.No......................... FEE._ • •d..............
Disposal nrk��Tffnstrurtion rrmit
Permissionis hereby granted----------------•-----•-...... -••-•••--....--•----•---------•••-----•-•------.....•---•------..._..••--...._......---..._..
to Construct (t J or�Repair ( ) an n iv ual Sewage Dis osal S
atNo......................................... ............. .. �------i'------
Street
as shown on the application for Disposal Works Construction Permit No______________________Dated..........................................
........................... ' ......................................................
DATE.------� '6 -- Board of Health
FORM 1255 A. M SUL IN, INC., BOSTON w
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sires P��v
Norte- EZ�1/A�7uNs e13sEa aA-J LOCATION
SCALE . .�.��'. �. . DATE 77
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PLAN REFERENCE . ..BL.n/G. . LoT .' . . .
S14oww on/ loL,Bid. 3 Z 7
=o EDWAR�
o E LEY
c.26100 v,
F GISTSPS
I CERTIFY THAT THE . .. .....a . . ... . .. ...... . .. ......
`ANOSUAYErL� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE : . . . . . ... . . . . .
/Vy� C,QpW�2G - /aE7/7'/O�►/E"� REGISTERED LAND SURVEYOR
Z SA&Z,.7-5
L 47.ao
TOP OF FOUNDATION
s„ CONCRETE COVER
CONCRETE COVERS
B.IS 'e a 4"CAST IRON 1I2"MAX. r '
OR SCHEDULE 40 IV MAX. •
P.V.C. PIPE 4"SCHEDULE 40 PV.C.(ONLY)
PIPE- MIN. LEACH
PITCH 1/4"PER.FT PITCH I/4"PER.FT. PIT
e.e � PRECAST
o' INVERT e a LEACHING
e EL,.38,35 INVERT INVERT P w q:i' PIT OR
e SEPTIC TANK EL ,g7,y3 DIST. EL 37r�¢ >_ . � EQUIV.
e INVERT
38 /D /oco ., ,, GAL. INVERT (30X G' a p ;�' 3/4��TO I I/2
e; EL.....,...... EL378j INVERT ww �;
� EL37¢o �. WASHED
L
�Z.3i..� •�� STONE
10
IA
PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
P- 33zz .
SOIL LOG WITNESSED BY :
DATE 4(!a. jo.°�98¢ TI ME./D:oq•A•'> S�/�/ !J�CdB// S BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 L-7.�,G✓, D L ,(!E7LL-'/ ENGINEER
ELEV. . . . . ELEV. 3�,yo
DESIGN DATA :
FBI
3<" 34,1 NUMBER OF BEDROOMS 3
Z`Z-374o C-Z_3l,yo
4g" TOTAL ESTIMATED FLOW 33o GALLONS/DAY
�ti� LiNE
Inc PHC.L'b� BOTTOM LEACHING AREA SQ.FT. /PIT/CS'C,OP.
SIDE LEACHING AREA , , �BB,So SQ.FT./ PIT/377C.pD•
GARBAGE DISPOSAL AREA INCREASE)
�q�• c-z.zBQo iq¢' �z �79p TOTAL LEACHING AREA .'��7.�d. SQ.FT
FitiE 7>&-S1CA1 �02 4s5 771AA-j rpuA
PERCOLATION RATE LC35. ?�/' .Tbyo. MIN/INCH
LEACHING AREA PER PERCOLATION RATE .. . . Z SQ.FT/CP.D,
.No .WATER ENCOUNTERED an/ PiT 1yi
NUMBER OF LEACHING PITS . . . . �. . . . . .�.
APPROVED BOARD OF HEALTH /�o DN .q2L
S/�E3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . .
DATE . . . . . . . .
AGENT OR INSPECTOR
I'OF ���SH OF
j a EDDW
i`14rzS�n/S L/a?./fir 26100 ySTS
, C.ci!y�s�fii D � /�SS `A��s p�VE+�e S4NRAR�p�
PETITIONER Nv6-- cp-6Wc--LL