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Home My WebLink About0087 VALLEY BROOK ROAD - Health 87 Valley Brook Rd Centerville A = 188-164 A } li 4 j �,he�td�fle� a 1521/3 ORA 10% P2 w LOCATION SEWAGE PERMIT NO. VILLAGE IN T l LER"S NAME i DDRESS 09 1�) ::� S DE R OR 0 MER � _ OA, TE PERMIT tSSYEDgo DA-T E C. QMPLLANCE ISSUED r FNo.o".`....27,.... ~' Fics.............................. THE COMMONWEALTH OF MASSt;CHUSETTS Y BOAR® OF HEALTH ......Q 7fl...............OF........ t.n .�� ._ ..............:---- 1M1.0ratiou for Dig os al Works Toustrurtinn famit Application is hereby made for a Permit o CAnstruct ( � or Repair ( ) an Individual Sewage Disposal S stem at: 97 Lf R �`1° K D� ._.. ` -CiA.CA ................... , ............................................................:.: lVe— �r� Location-Address -�Ta�,, or Lot No. .__..... caner Address a � o n no ro sD. _ � ...--•----•-----•-•--•--- .-------- •--•••-•-• -..--••-• --- Installer Address ®�o Type of Building Size Lot__��_____________________.....Sq. feet Dwelling—No. of Bedrooms...........:............................Expansion Attic (1Jc)) Garbage Grinder (►,►o) `4 Other—Type of Building No. of persons............................ Showers Cafeteria Pa Other fixtures --------------•-•-•---------•--• W Design Flow............V\.©..................:...gallons per person per day. Total daily flow............................................gallow. WSeptic Tank—Liquid capacity PQ®_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 >y Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.._ K ....... ___. .a�-'.................. Date.._. .---3 3.__.... as Test Pit No. 1........... per inch Depth of Test Pit.................... Depth to ground water........................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------.___.-__--_._____ .. -----------------•---••--•----.....---.............--------.......--------•---....--•-•.....-•---•--•------.•..........,..-•••--•-•--....... O Description of Soil------.Q — i»- ,G ^^----------•-�•--------• 10 s xw .. c, q . ----------------- 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 TL ITS 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. A� - 8 3 Sign/ C. =�="-----U`� . �` ...-•------------...... �- --------.............. ... •--- Application Approved By... = L/ ------------ Date Application Disapprove or reasons:--- ••--------------------------------------------------------------------------------.....--a••.............. ---••••-•---••••-•-••-•••-•-•-••-•---•••-••--•••••--•-••--•....•--••-••••--•-•••..............•----•------•--........•-•--•••---••••------•-•••-•-•.................................................... Date PermitNo......................................................... Issued...................................................... Date No.. 7k. ^` Flms.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---.... ( ...............OF......... G C n ), ....................................................... Appliration for Di-gpnoFal Works Towitrur#ion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: , .......... ------------- ------------ ......... Location-Address or t No. • L )c s.m 'z. - .......... �='-n-=-� _�ac s........ e.. ----...-• ...._...... -.........-- wnerAddress a r l� 5. ! Installer Address Type of Building Size Lot__......Q ..�......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (W,, Garbage Grinder (N ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------....................................................... W Design Flow.............U._.....................gallons per person per day. Total daily flow____.__....... ._.._._...._.....__...gallons. WSeptic Tank—Liquid capacityA __._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 ( ) W Percolation Test Results Performed by..... ......d._.._N. '`"'................. Date...._ !...._ '.... '----_.. ,.� Test Pit No. I................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........................ ---•--------------------------------•--•-------------------.----.----------•••--------------------- -- ...---•-------•- ---------------------- O Description of Soil.......Q.- -�----------."rN\ `'U ^--------... �----------�v\ v ........................................ ---------•------------............--------•----------------•---------------------------................................................... W x •••--•••--••-------•-•------••---•.....•--------•-----------------------•--••--••••-••-•••---•••••-•---•••••••••-----------.....----•••••••--•-----•-•••••••••----•••••••----•-••-•••-......-•••--_.•••- 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. g 83 Ite A �* pplication Approved B404 �'`� ------------------- DateApplication Disapprovedwing reasons:............................................................................................Da.t e.............. ........--•---•---••--••--•--........•••.•••_._....--••••••••.......•••••••••••---••••-----•-•••••-••---•--•-•••••••••••••••-••--••--•••••_..._..•••------••-••-••••••••••-----•..........••--••......-- Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .....................o F..............-�.......................... ................................ Trrtifiratr of from lt�aatrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( v f or Repaired ( ) bY---........ _e .�.... U..........-- =•----•--•---...--•--•----------------------•--•--------....------•-----•----------..........._.....-------•-------•-------•------•. Installer 1 at -- - -•......................... has been installed in accordance with ti e provisions of TIT 1 1 of�The State Sanitaryd . s gibed in the application for Disposal Works Construction Permit No.... ._.................................. dated.... __- _ ......________.__...._.__...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.�� ...........0............ �rn � \- C� tp� _ ............... ..................................... No... ��.:."�_ _ FEE....l................... Viopos a1 orkn �o ao r inn permit Permission is hereby granted-------- ............—e ro-=S............................................................................ to Construct ( for Repair ( ) an Individual Sewage Disposal System., \ at No........\--,=...................�.--\............. A ce Street ,�� as shown on the application for Disposal Works Construction Permit No.............. ate ........................................ ..............................• -----------�•-•••-••................•-•---......----- log. oard of Health DATE-•-• -- ----•................•-•••......-•••••......• ` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r - - 5►NGu= FAM1►-`! - %3 B�ORooM i - ., . ►JD ,GARBAGE (�QINDEI2. ' o�►�Y Flow _ II x 3 = ' 33c�G.Pp :? t ISEPTIG TA►JK = 330XI54>'/• '�95G.Po r U5E- 1 000 � o15Po5At_ P1T v5E tv o0 GAt_. '` � 150 6.F x 37 5 G.p o -=---- 50TTOM AV-F.,.A: .• Yo S F, o 5a S.F x 1• 0 yip G.>'o,". . a ^ToTA 1-. V'E516k" 4Z 5 G.P.D. ►►�► -1'oT .. p A1A►►-Y FLOW 330 C.P. 22L ��`Z35 � paZCoj_AT1oN RATE► 1'11W VAIN OR-LF=:$5, 14 Y � o •; SN Of bf,� 2��P�ZN OF y,� 4� io ALAN 9G Q 1 (�� H R RiC A D o W. a I �, A. .. J ES �� , lO \ BAXTER n 1 �51 l I ?N a 2•40480 4ry° SURD TEST �F�/$foG • 38•O TOP FND� .39•eo .37 p zY mv• -�•!� r, . ►oou INV. f/mac..-Loq�/ 016T INS GAL.. �s�c?soiU e�,c SsPTlf- 3414.3 1000 1<JJ .3L.� TANK . • LEACu PIT INV. INV. wlTu .3.;r 7 �I 1�3/9•IVL WASNGD 6•Tv N6 ---29:f n/dr vf�.e7: C.E RT I F I G 0 P 1-oT P L.A.W 315 ;. PROFILE l.oc4-TIcN ►JO 5CALF p L.p.1..1 REF E1ZEN GE . 1 CERTIFY TNAT THE F'ovlv�A�"�V�NOvYN --- HEREON GOMPI..`(5.WITH-TNT S 1 cEL1N� _ •. •�-•n-�- 1 Awes S L--T e4&.C.K 9r.QvIu•EMEN'r> PF -tµE l..G. 35- Stt-ap 'TOWN O F IJ STA��A N 1 S I�oT LOCAT D W lTN1 T Ir- F oD P I N DATE BAX'TSmd NYE INC. REG 1ST faQ6�'I.A►10 5 u>zv E`(oZS I -Nl!j PL&1J 1 fi NOT gA56U Gtd AN OSTEI2.VILI..Jr • ems• f1u51-RuM6N'l' Su2vC--Y �--TNEDFF5ET5 Sucu1,� 11 ,, NoT DG- V.jGt)'TC' DC:'rc:.s•..MINC: L�'� VII1G�� APPt-IrANT LOCATION NO . - VILLAGE -a - -.► DATE APPLICANT _, TGcM'P_� FEE _ TELEPHONE NO. � S n-refundat ADDRES 4 ;ENGINEER TELEPHONE NO. DATE SCHEDULED fAppl icant*s -signature t - _ SOIL LOG SUB-DIVISION NAME "_r DATE_ /,3 3 - TIMEe!!� ' p EXPANSION AREA yYESje,0"N0 ENGINEER -v }, TOWN WATER j ,"PRIVATE WELL - ,��- ,�� BOARD OF HE EXCAVATOR •SKETCH: _(Stiee.t--name, dimension s '-of _lot;:exact location --of- -test -_holes and --7n percolation tests,-=locate -wetlands--irr -proximity -to=test holes) �- NOTES: 01 PERCOLATION RATE: - TEST HOLE - NO:O: - ELEVATION: - _ TEST '-HOLE NO: +Z> ELEVATION: _2 4 - I - L _.5 5 { 6 6 i 8 g . I 9 9 1 10 10 -• 11 11 . 12 12 13 13 - 1414 15 15 16 16 _ SUITABLE FOR SUB-SURFACE SEWAGE:. . LEACHING FIELD /LEACHING PITS LEACHING TRENCHES �' ' r UNSUITABLE' FOR SUB-SURFACE SEWAGE. REASONS: NOTE : ENGINEERING PLANS, MUST SHOW NUMBER ASSIGNED ON PERC TEST PP CATION ORIGINAL: COMPLETED IN ENTIRETY BX P. F. AND RETURNED TO BOARD 0 HEALTH COPY: RETAINED BY APPLICANT LOCATION SEW E PERMIT NO. VILLAGE C A-7f4cl %L c F INSTA LLER'S NAME & ADDRESS U I'L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Sf a �'