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HomeMy WebLinkAbout0060 VALLEY BROOK ROAD - Health 60 Valley Brook Road IN Centerville A= 188 - 166 kw OPendaffMC n q. o D 0 a Esselte 42101/3 ORA I 0o/0@ P4 a i u a 0 lQ 0 At �4 mSe 37�7 +* LOCATION SEtvAGE PERMIT MO. /-®T# v14c,LGY /Ii?vo� VILLAGE C Eik-TEW U!L t k INSTA LLEWS 91AUE b ADDRESS F MiCI" Ag.®s _Pt-c- 19A x A-,0r��L� aUIlDER OR /OVMER DATE PERMIT ISSUED 7,���_ DAT E COMPLIANCE ISSUED /� �� r 370 �Il y �J 37',r i 3� No...19 Z:_22 ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................OF......... �'' �Y� \�- lY ------------------------- ApplirFatiun for Uispwi al Work,6 Toutitrnrtiun Famit Application is hereby made for a Permit to Construct (LI�or Repair ( ) an Individual Sewage Disposal System a : LoqZ-Address - �d l ............ . or .......... ._........ ......_..._ -------•---•. .............ei 4 t o. _.. -- ,Wa •-•- Addre sOwner - `� � '•- ••--•---• --� �-'---------•--•-•....... ......•--------��:w� � ' -----..._.............---- Installer Address S`13 S� Type of Building .Size Lot--- ...... q. feet Dwelling—No. of Bedrooms_____________3___________________________Expansion Attic ( ) Garbage Grinder Other—Type of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ...•-••---------••-----••-•----• - W Design Flow..............0_______________________gallons per person per day. Total daily flow.................. ............•-__._________gallons. WSeptic Tank—Liquid capacity!0Pq gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosinnk ( AA ,, ~' Percolation Test Results Performed by--- Glt��_____ ______k_.___ `J*.''"r__.__...... Date.....k.D.... ..... aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water------------________-.-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....___________________ 0 Description of Soil--------0_-_ -- a`! '�2S_ ...`----------------------------- ------ x - ' .•••--•-•---•--.5- '!'�-•�••-- �t��'''� ............. ---------------M t..c,..----------------.-CJt .......----------------------------------------------------------•--- 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 TI'L U 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 ----•----!(-/ .................. •-••----•----•••--••••.... Da - Application Approved By......... -----` �' --- -- --------------------------------------- .113 ............. Date Application Disapproved for the following reasons:.......................................................................................... .................... ................................................................................................................................................................................-•-----•---•---••--••---- Date PermitNo......................................................... Issued.............................. .•---------------•-------- Date L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `..o-p n OF.......... .P—N C"-�A-C.{� �,�---' ...... .................................. Appliru#ion for Uispnuul Works (foustrnrtiun Prrutit Application is hereby made for a Permit to Construct (6_111�or Repair ( ) an Individual Sewage Disposal System at: .......... • UN,•- .............. .......... ---•--.._...---......--•------------------.......------••-•----- �.+ .. Loc�tpn-Address - -... �. G: :..... -----------------•---.----- ............................... Owner c� `? Addre{s a _ ..... .-�.......................................................... L-..-�. ` ...................................... Installer Address Type of Building 1 Size Lot...... %.....Sq. feet Dwelling—No. of Bedrooms............. ............................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............... No. of ersons_.................:......... Showers — a yP g ------------- p ( ) Cafeteria ( ) Otherfixtures -----------------------------------------•'••••• •----•••'••'------••---•'-••-------------••-----••-•... r ._..... W Design Flow............ N..........................gallons per person per day. Total daily flow.__.............. ..Q...............gallons. WSeptic Tank—Liquid capacitA 99 ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing-tank ( ) aPercolation Test Results Performed by.__ .C :__ _h..... ...._. .`''`�"'_..._...._ Date.....:=_ ... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per. inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.......... s�-.-_........�-�_��_.� .. � k.------------------------------------------— = \-- --�.............. ''e_,..........•---- c `, ` .------1 -- ---------------------------------------------------- - -..... 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 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. V" Signed .....� ..._.. -----•- D Date Application Approved By.......... ----------- Date Application Disapproved for the following reasons---------------•--•----•-----•--•--•-----------•---------------•-•---------------------------•-----••--•-••••---- ------•-•-•----------------------•-----------------------•---........-. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH TOertifirate of Tompliunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( —j'or Repaired ( ) do rya I taller \ atr= ` ---------------•---- ••-----•-. - --------------•---------------------------- `------------... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- ."'-p? ........... dated-......... --------------- ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED 4&A GUARANTEE THAT THE SYSTEM W11 F CTION SATISFACTORY. y. DATE....l©-. �2- ...................:•........----•----------...... Inspector.. `21...` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � La OF................ .� ..ti.f.�13. i 1� No....��........3�� FEE...�. .............. Disposal Work.5 T-Fnnstr inn rruti# Permission is hereby granted........ . : �� "' .S .. .. .............•----•---•••-•-•-•••-•'--•---••-•-•-•--•-•-••-••••---............--•'•'•_.........___.•••--•...-•- to Construct or Repair ( ) an Individual Sewage Disposal Systettn at No............ ' ...........:.:. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Board of He tlf DATE..................................... ................ FORM.F,ORM. 1255 HOBBS & WARREN. INC.. PUBLISHERS Z 1 S1UGt_� �nnnt��! - 3 F5»e�o�vl -d T�t�.�! Low s 1�t> •c 3 t 330��•p•�. •� / �EPT-1 C T -1 k = 3�O.r IS G 'J'o • 4`��j ts.P.D, �` w / USA- 1000 6.4L.. \�0,00 EAU' �►SPDSAL PIT - uSE. loco GaL, � , �h P S�J4.LL Av-G A = 150 s.F. I So 55z' 1 2.S S75 G.P.D. =;c> sue. ND ri 2.(0 ToTA L 'V ES16Q = 42S G•p D Ti1„<? I PE.rLCDL T10Q PINE : � lU 2.MIW' 02 LESS.Of d WCHARD 5 A. y, / AL r1 BAXTER jot, Q T%�'t ti /� g � �` � _ �ti i fit'• . TeST-122d. �'G=3 Tor rwp =,41 jai n Lo&w% A Iuv• g7 SuR�50Il� 4 yv� 1W. 1 GAL. .8 Z� r "Sox G SEvnc 10 wv Goa25�: 1000 3L. t tw. 5�,10 y LAN 3 7- 3�,¢ Pi T WAS►1ED f STON1= 3p -- 1i j SAID Ce=QTIFIED pLoT F�L./11.,] 1 EL. PR.pF-t LE-=- L OCATI o -4 «% 1 Z I 5CAL1= I) -(od �AT� �o-g 'f3Z- I Cmv-1'11=,,4 Tc4AT TI-tC-- t-lF.I,l:nl�l CCW%PL`(S W ITI-1 . I T 2� AWE> '>EV.1 TAC14 t7CQUIQEAA&"Ty of TNC: � Q •TO\AJQ c CJA-rt aQXTr- Inc. RCGISt���D LAWO THIS C7f_A►-� 1�+ t�OT LASES Oa4 A►J OSTEZ�/1l_1.G o MrLS`"i, I�JSr�J�✓lC_w; %L�c_.iI_Y TlaL. c��c=5r�, 51�cwta n.F>Pt_IGA.I�1T" ( r/ i.(..r l;l:c U�>C i� (L, t7r 1'Ct;MI►Jl= LG•Y- `r\l f c.,c7 �M 1714