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132 Applications & Permits No...:1 =' 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �A LL OF ih"""'o- Applirtttinn fur Ilispnsttl in nrks (Lnnstrnrtinn rrmit Application is hereby made for a Permit to Construct ( ) or Repair (Kan Individual Sewage Disposal System at: ) Type of Building Dwelling—No. of Bedrooms Other—Type of Building Other fixtures Design Flow Septic Tank—Liquid capacity Disposal Trench No Seepage Pit No Other Distribution box Percolation Test Results Test Pit No. 1 Test Pit No. 2 or Lot No. Address Address Size Lot Sq. feet Expansion Attic ( ) Garbage Grinder ( ) No of persons Showers ( ) — Cafeteria ( ) gallons per person per day. Total daily flow gallons. gallons Length Width Diameter Depth Width Total Length Total leaching area sq. ft. Diameter Depth below inlet Total leaching area sq. ft. ) Dosing tank ( ) Performed by Date minutes per inch Depth of Test Pit Depth to ground water minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or Alterations—Answer when applicable. . fr„_ iezc....Ce r%x <"'Ad A,yet1, /-5 -Clezh U rl-L4' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep issued by he board of health. � �/ Signed.. r 6c.... ... . Application Approved By J.-t a-t .: " ) ILO; bate Application Disapproved for the following reasons• Permit No 171.0 7 Date Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' OF /), &ridicule of TnittpThiatur THIS 1$ TO CE (TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (e ).' I? " by Installer (f at / •12 has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No %LC / dated /La :Av../ 1 t" THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ' 1 1 74" Inspector T 1;1 ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a- OF bz,,ge-c No 7 / (.2 niglinattl arks Tonstruttinn Permit Permission is hereby granted, to Construct ( ,) or Repair c1 -an Indwuli#1 Sewage Disposal System at No Street / as shown on the application for Disposal Works Construction Permit No l-1 Dated . Board of Hata J 4 DATE FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \pplication for COMMONWL,ALTE y(W NASS\L IIUSL.TTS it`- Board of Health. N -t .HICMPT V3 MA. APPLICATION FOR DISPOSAL SYSTP1 CONSTRUCTION PERM! FEEl — V Type of Building EVVSi' 1)/ 'e-UuJC. Lot Size sq.ft. Dwellin g . o.of Bedrooms Garbage grinder NO N_ Other-Type of Building No.of persons Showers( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 33b gpd Calculated design flow 3 SS Z Design flow prmided 3SS,L gpd Plan: Date S c t DI Number of hertz Revision Date Title 5 if el-v Sptu i 2672m& D PC.RA-DE le)(- (2, 2_Lo-ZT i-AN M S .Crr c Description of Soil(s) GLRSS-1- SatL — S _r2 Soil Evaluator Form No. (plei Name of Soil Evaluator 1 .nail eld Date of Evaluation y/.RQVD/ DESCRIPTION OF REPAIRS OR ALTERAI IONS —A1S7-/i'L C- ,tX74J <--- /'U6 4??cU) L=- :sip x W = I i pee n+ =9' As POL /"7tm- A--,c) rnaer The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees of to llasee the em in operatic' til a Certifica of Compliance has been issued by the Board of Health. Signed NLY'/ Dat r�VG' Inspections ' Location 132 Lass; FARMS tetvRD Owner's Name GN-J O C4 s./ 1 Map/Farrel# •+t t , Address 4 3 n; I UC � .''-� Q.Fifl R� 14 /n9' Lot# felepbone# 413 -5-. 5%Q6 Cat ,56„,4.6931 Installer's Name C.412 IS SEe.c2sz Sc ni Designer's Name ERA 651- J )41A1-4-44 VS Address (31,,,2 A-Lb r- 1 hi Sr w4)w1,) rrFA- Address lie: Q kii€y (ZofO , Cx+tw , m,0— II Telephone# 41 �— 5?1 3-3L3?, Telephone# 41 -513 SD33 Type of Building EVVSi' 1)/ 'e-UuJC. Lot Size sq.ft. Dwellin g . o.of Bedrooms Garbage grinder NO N_ Other-Type of Building No.of persons Showers( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 33b gpd Calculated design flow 3 SS Z Design flow prmided 3SS,L gpd Plan: Date S c t DI Number of hertz Revision Date Title 5 if el-v Sptu i 2672m& D PC.RA-DE le)(- (2, 2_Lo-ZT i-AN M S .Crr c Description of Soil(s) GLRSS-1- SatL — S _r2 Soil Evaluator Form No. (plei Name of Soil Evaluator 1 .nail eld Date of Evaluation y/.RQVD/ DESCRIPTION OF REPAIRS OR ALTERAI IONS —A1S7-/i'L C- ,tX74J <--- /'U6 4??cU) L=- :sip x W = I i pee n+ =9' As POL /"7tm- A--,c) rnaer The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees of to llasee the em in operatic' til a Certifica of Compliance has been issued by the Board of Health. Signed NLY'/ Dat r�VG' Inspections C /- CI)'1 1OlNl\\'F,1LJF1 OF 1\1A'SSAIITRISFTTS Boreal of Health. IJ:PT11=1C;IL OF Lo1'1PLLAN'CF Description of Work: J Individual Component(s) J Complete System The ondeut lied herchv cerrif Odd the Sewage Di.pnsal System: Consmmred br: 1/S. at /3z — Repaired FIE Upgraded ( ).Abandoned ( ) has been installed accord h uc with the p (> >Ci 10 CAIR I DO (fide 5) >>d she apps 1 de pla milt plan: elating apps idiom No. O/-2. sated S" /y/0/- Apt :c ed Design Flow 3 gpd) Instiller Dc.ig r:_ -d 7 h Dare: Co//14 / The issuance of this permit shall not be construed as a guarantee that the system will function as designed Silo/ G ; CO MONWhidill O1= ) 1:1SSt CI1l!SLTIS BOOM„iHeank, DISPOSAL S'STIN CONSTPI'CII)N 1?Fl?�11I 4 FEE 3' Permission is het thy granted to; Construct( ) Repair(/ Upgrade( ) Abandon( )an individual sewage disposal system �h1L as described in the application for at �3,D kosf al14& i Dispc cal 5vsrem Couslnicdon Permit No. i�V-5 dated 37/(///. Provided: (:on s i l t c don shall be completed within three veins of the date of this in .y loyal co ns must be met Date-6/1V Board of Health ° -4/ // e'Ff---•--,'C- .