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Home My WebLink About0095 VALLEY BROOK ROAD - Health 9 S va cley 6cao k Cen�cv111e, 181 - f56 I I i i I SMEAD No.2.153LY UPC 12934 smead.com • Made in USA I � I SUSTAINAt�II� WMATIVE CMIWdflb�riourdn0 i i I I i I I i i I I I r _ IU 9949�� No.......8_.3=.6.s 7 FEs......4Q............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vcrwln...............OF....... 4 Appliratioll for Uii,vusal Workii Tnnitrnrtinn JIrrmit Application is hereby made for a Permit to Construct (,X or Repair ( ) an Individual Sewage Disposal System at: .....---... �broQ�v-----..:\�a . Al 1�..:............ ....... .................................... Location Addres or Lo No. - .a ci s..........K:....... frA N: ............. ....... ..a► n_ .. ..............:...................... W e'TO f Il .............Own ® 5 dlf n__a'�0.� dress Installer Address Type of Building Size Lot.a 55�(.l.._..Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (439 Garbage Grinder (L)q aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow................... ...............gallons per person per day. Total daily flow........... WSeptic Tank—Liquid capacity0 Q-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 ( ) Dosin tank ( ) ~' Percolation Test Results Performed by... - .k .....%9...... `V...............•.. Date....:'k 3-$-3 - -. 04 Test Pit No. 1................minutes per inch Depth of Test Pit.............. Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water -- w-a ter..............----.-.---- --•--------- -------------------- ---•--• ----•----.......••--------................._---•--•-- Description of Soil----..... .........0........ Q •............ ........•-- amU ---••-...---•--•-----------••-••--•........ I . e- a aA------------------------------------------------------------------- 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 iITLL 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. v11 Signed C. ------..... ....•-_.. .---.O-Ld . a �D'atq Application Approved By------------. ............ . .. ..................................... ate Application Disapproved for the following reasons:-------•-----------------------•------...---•-•-----•-••--------------------•--•-------------•-----•------------ -•------.....-•------•-------•--------------•---=--------•--•---••---------------.............-•----......---•-•--•----------------•------..........---------------------------------------•----------•-- Date ` PermitNo......................................................... Issued....................................................... Date ------------------------------ --- --- No......... ...J=.6.5 7 FEB........ 40........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \��,.�n u-- n 5 k �� ............ --OF.........................................------------•----.......... .-.-............ Appliratiun for Ui4pusal Workii Tonstrurtiun ".truth Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �ro a V \v `QV.V ..... ..... .. Locati n-Addres C�V or t No r USE' s M, j cA r(r\ .............••--•----. -•---•-----•------............---•-•-••----•-••....-----.........--•--• •.........---•-••••••---•-......_...................-•---------•---•-•----........................ r `O , I CA n V •C"�r.•r o owne Installer Address Q Type of Building Size Lot................... .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures - - - W Design Flow............................... .. ..gallons per person per day. Total daily flow............................................gallons..Septic Tank—Liquid capacity 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 ( ) Dosin tank ( ) ►� CA-V-k eA �U` Date. Percolation Test Results Performed bY..................................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................:...... ........... ....... .......... .:... ............................................... Description of Soil v ------- x •.--•-- .. �` �•. -•••-•..::J S^.`�� :..-----••••--••-•.............•---•----••---..•---.......... W VNature 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 TITL- 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......... cC!Y�(`s?�.• '= � �`'�3� 3 Dates Application Approved By---•--•---• e.._-- 71�;p ��al�/l J , '-•-•--- ate Application Disapproved for the following reasons:................................................................................................................. Date PermitNo......................................................... Issued....................................................... y Date THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................. ................................ Trrtifiratr of Tuutphaurr T I �I O•CWIFY, That the,�Individual Sewage Disposal System constructed ( Vror Repaired ( ) �nl by . .................... ----•----•------- Ins 11 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---B•3-_ .��......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS ACTORY. DATE. ......................... Inspector...... ,t--------•------..................------•--•---•----.......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......: .............OF............ ..-c!. ................... No........................ FEE........................ Diopsal Works Tundrurtiun rrutit Permission is hereby granted......... .............bt ---------•---------•-•-••--------------------•--..................... to Construct (✓f or Repair ( ) an Individual Sewage Disposal System atNo............... ----------•1 \)-. .............. Street as_shown on th/applicatio for Disposal Works Construction PeermmittNo............... --_ Dated.__._..____._............................. 2/D / Board of Health DATE ..... . J--•--------------••----......--••--------...... FORM 1255 A..M. SULKIN• INC.. BOSTON r p� Slc.Ki � ��1►� GI..C.. FAM11-Y - ;S EEORooM a Wo GARBAGE: (�21r.1DE2 oAI�Y FLOW z IIO x 3 - �3oG Pq SEPTIG TA►JK = 33ox15�% � �97G.R ,I u51= loon GAL. i o15Po5AL PIT V51~ 1000 SAL. � '� l yo 5.F X z•5 = 3? 5 G.Po 1 ZG 3� �o F, go-rTOM AREA= .. 5. 05 5 x I. o -. 0 ToTAt- -Te>-rAL DA I l.\( 1=\-OV4 _ 33o G.Po I r Z i, PE2COLATION RATE : I77 10�IN 2MIN o�t_E55 Of 1 ` ' +A y O ALAN i WILLIAM G � o W 1 C. 0 \ I og N Y E N ,. ONES c� p No. 19334 O o. 25'.i0 su �B. Top FNL) t-t II 40 s INv• 3.7 5 .Ccu1.YJ a toot) II SUlLfoii_ DIST. INS G°'k. 37•3 D�K Z 37 EPTIC./ I 000 INS/ TANK IS c.L. 3G•f LCAC" PIT INV. INY. wlTu 3G. 7 3G9 II WASN6D 6TvNE .3a• s CawrIFICD PL07 PLAr.1 _ ,S!v K/•sr P4ZoFIL �044-r10N C�.crr�,21i/G G�— No. •SCALE SCAL, ,y a N C,E C E a-r I Y t H AT ?N E W� 6-r,0,16 5"C)wN NEQEO W CoMpL\(5 WkTN -T NE S I o�LIN X O 7 /8 A W P SE7TeACK R-6QUItz.EMENT� oF -Clu� -jo W N C>F 4WD 14, ►�f vT LOCP,T D \NITA IJ TN Fl.00p �LAI►J DAT1✓ 3 � C � 6AxTEcz.e. NYE INC. W-SG15-Trc-2E=•D I..AuD5u7-v�YoeS -f1115 PL/�►J ► S NcYT (3t ->c D o►d AN aSTE2v1�L� • MASS- -r HE n. I=FSETS 5uvut� J.4�yEs �. yir� L O CATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS �/:�,Z/L4/ Liz BUILDER OR OWNER ' DATE PERMIT ISSUED vJ � , , DAT E COMPLIANCE ISSUED®O y� � 0; 1 �� s' j