231 Septic Permit & Plans 1998 Il9rphoue# Sg b l& IILF
Type of Buildine lit Ltd d6
Dwelling-No.of Bedrooms
Other-Type Building
Other I r
Design Fow(min required 44( 1 1 Calculated design flow tit(O Design Il w prouder! 46itc
Plan: Dale 0.2c //E
Number of sheets
qS 113 PC
phoncN ,i(3 V61 77 z<9
No
Lot Size boo 4 sgrlt.
Garbage grinder
Slum co O.Carew' ( )
Title
Description of Soil CO
Soil Esaluatnr Form No
DESCRIPTION AF REPAIRS(As AFFERXI IONS
in►a I • . ae/n-10 /de
Revision Reiision Ditie
gpd
Name of soil l:valUnmrKrJICtIFId Dare of
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the p
further afire to orb rce the ry st em in of until a Certificate of o pliance has been issued by the Bo
Signed f. -BLS CH, gkohoc. Date 8I rid
lushes d
COi iNONWLALTi) OF \I\SS;\I 111 SLTIS
Board o/Heal/h /� o,P�J✓fFn
CEPT11:TCATL OL COhIPLI ANCL
Description of Work: 7 Individual Component(s) gtomplete system
The pulp nrd hereb ui at f' th h Sewage Dispos S a n: Constructed ( .RA pored I ). Up(; ailed O.A6umd
e
by /' J 5r
at X31 4 S. L •rti �0 l-<&
FEE
has been stalled in accordance -ith
the I 1 -r F 110 EtvIR 16110 pride 5) and the l l 'card do
p o
applicaiion No 7 7 mated 4 7f yf 1p cyetiD Flow �jG�•Stpul)
Installer - / , �- ..
Designer
The issuance of this permit shall not he construed as a guarantee that the system will function as designed.
No. 1- (/
COMMONWEAl. OL N,ASSA[ Jll'SLTTS
Boani /Health ClerMillgreDAJ
DISPOSAL SYSTL I CI") JPLLIION PLTRNIT
P
Permission is hereby granted to; ConsttrrJuuct Repair/) Upgrade( ) abandon( )tut individual sewage disposal system
at 2 I fdilQd f�l7IJ tCC) �..D as described in the application for
Disposal System Con strunion Permit No. "r7- � /,dated 2/. ?fr c.
Provided: Construction shall be completed within three years of the date of this per yiih All lot al condipons must be met.
Farm 1255 Re,, 96 AM.Su IA So bbso' MA
Date C:4; Board of Health
COT1h10NW1TIALT1-I OF 1ASS;\C_ USLTTS
w
FEE
APPLICATION TOP DISPOSAL SYSTT 1 CONtSIP1'CIION PFITI\ IT
Application Cor a Permit to Construct Repair( ) Upgrade( y Abandon( ) - A Complete System 7 Individual Components
Ioeation 03I 44.11301,bni ten
Owner's Name
_ oCa
Map:Pa,cehi
Address 2 A / :.• ■4 i
4
Pot#
at' 'S ca�h re
Telephone# 5' 33og
hisrallens Name Alli
Designes Name
r' +PO.S'NEi-aArV
Ssot l&Jc
1tt6 .
Address PAOLLi 1'194
Address— -tuo2 Cr C.0,aq MA
Telephone# S8" b 1$1,-
Telephone# 4/l3 '461 ?23$
type of Building LA) .t_t siG
Dwelling-No.Of Bedrooms
Pat site
Gal bage grinder
(
Other-Type of Building No of persons Showers ( ).Cafeteria ( )
Oi her Fixtures
Design How ( nin_required) tkqn gpd Calculated design flow `MO Design flow provided Z.'csi gpd
Plan: Dan (z< Number of sheets Revision D ,
Title R r �R113 Pad
Description of Snil(sl t(,J
Soil Etalnator Form No.
Name of Soil Evaluam
17J___F+f£_44hi Date of Evaluation 6/2r
DI'ISCRIPTION FREPAIRS • AITIRAIIONS ava-
"PM yrviMR
ROBE'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the ovi$ijMs td
further afire;_ to o s p ee the stem in o•er. ion until a Certificate of o pliance has been issued by the Bo
Dale OfuclB
Signed
svs watt
Inspeninns
,a /26,l72S
Commonwealth of Massasetts
City/Town of % h
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer,use
only the tab key Address
to move your
cursor-do not
City/Town
use the return
key.
2 System Owner.
F 0 C`1-171o1 'p
EX ;TI P. 00 &fJ 5117,
Address Of d Rerenf from location)
State Zip Code
City/own State _✓q�Jg/ZIP Code
,c r/ C:1\)Q ` lephone Number
B. Pumping Record
q l
1. Date of Pumping 0� C, ���C/` Z. Quantity Pumped: ISO
3. Type of system: LJ Cesspool(s) /_ Septic Tank ❑ Tight Tank Ti Grease Trap
' ! Other(describe):
4. Effluent Tee Filter present? ❑ Yes 7IVO If yes,was it cleaned? Yes [I No
5. Condition of System:
6. System Pumped By
Nam
Company
7. Location here contents were disposed'
Vehicle License Number
Signature of Hauler Date
Signature of Receiving Facility Date
Inform4.doc•03/08 System Pumping Record•Page 1 of 1
ICED STONE
iS
-SEPCe.7a,J
ALL POP SDI L AID 51 SSD IL FIX A 0ISTAIIE
OF 5 FEET IN ALL DI RECT106 ARDUO TE
LEACH I ND SYSTEM (SIYCe AREA) MIST E
IBP4D AND REPLACED WITH CLEAN FILL,
APPO.iD BY BOARD CF IEALTI.
0'4-
- 4) qi
k,25 1
45
it
As 5.iLLT
, 191241
-
AUDUBON ROAD �-
$n &)CTL o,3
ciNFc' a >?a
u34-rva L„Jt 4a'ssl.&
C.a.'WEP u^L
:"r 7 3rn5
icsc� , 3l'11-7 cl31{!M
3� r j�r?N,� '•�_ civo i NOancnv
(NO 31o0i "3sy`® 0
O + �--.y dy�^
es1 ��� -
\ , Illr irWas w 5,56 ... ..-- – � �- -sb
I .--ss �_
lb lb
\ .
-b,0 c,I
'14.1.713H 37 CANON AN a3raNa Y
'1113 Nv3b NI.l M CBOYIEIN an a3la{321
3a Gsu (raw mm+e) uvlNI Th eti c c (0
3LL a1CNY CH IJT3NIa CNN MI 1333 s 9 \.11d �
3anisia V NCH 11OSB'6 an Dios dal m
s'Y roil ra70.75'
1-
-k > I< t/ • 1
/L,
�_ O
-3n .z1/1ams/�£ 7v
,0* = „L d1Y.A
SSM.I 'A8NY D
'x111 salvlooSSV NM4331S 'd 'tl
(�Clg,n.vb 96, ii t-
96.6 6 -
t7Box
NEc<) COo 6F4.
.
Cor- —
SE?T,4 -TAW K
°8R9e
hm...r cM'?mSce
PROFILE OF SEPTIC SYSTEM
WITH INVERT El FVAT IONS
NO Scale
See' "Jo re-
CROSS SECTION OF LEA<
WITH ELEVATIONS SI-1CWN
_ / ,rormum
MOT/P•