Loading...
HomeMy WebLinkAbout0100 VALLEY BROOK ROAD - Health �ntei Valley.Cville t A=-,188 15 8 1 t' 6 ' o *Pendaflo)C Iz Esse/to 42101/3 ORA 10% ,,• P4 0 v M 1� O LOCAI101� SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS V E ,64©5 - .ram-L • U I L D E R OR OWNER DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUED � J r-T v F Now �3� No , ......... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �^ ..............!..O.' e........OF........... ..Qt s..... ." .\� DLf Allvaration for Uhi uiitt1 Workii Tiltuitrurtinu Vrrutit Application is hereby made for a Permit to Construct (_�or Repair ( ) an Individual Sewage Disposal System at ......�1. � :��e... .....- - ------------------------------------------ ----------------- Location Address• pr L—ot N,. p a Owner amAd ess -- �� c Installer Address vType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion...........................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------•--•----...---••-.-•--•---•••...---••--•---•--•-----.....__........--•--••••....--•.....................---...... W Design Flow............,._o....................gallons per person per day. Total daily flow.........3.3.......................gallons. WSeptic Tank—Liquid capacitAOO .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 ( ) Dosi ank ( ) '~ Percolation Test Results Performed by. .. .................. ......I_v.__. .___._ Date.....V k r.�....................... Test Pit No. 1................minutes per inch Depth of Test Pit..._.._....____..... epth to ground water........................ Cq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............._......... R: ..... --••--••------•- ...._-- O Description of Soil.........�)n:-............1.o ar.•............. ...........5�? a. - ................ - - ........- x ---- .............................. ...-.----........5_�..r.__ ^y... ........................................ c.� UW --------------------------------------- ------ -� ^---------------- .......... ¢- 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. ---•_....•Application Approved B ` -----•..........•--•;•-.-•--- ?l t .:......_ Date Application Disapprov following reasons:............................................................................................................... .....................--•---•----.....-••••••-•••-•---•----•-•--•-•- Date PermitNo......................................................... Issued........................................................ Date y N6i4 - FEs. ..yQ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tit.P. `......OF..... ...G7l C-.(�..5.... .CO Appliration for Mipviittl Work.5 Tuntitrnrtinn JIrrmit Application is hereby made for a Permit to Construct (.■^01-0"or Repair ( ) an Individual Sewage Disposal System at: .\a � :::...-_-. ..�................. ....... . ........................................................... Location-Addre s r Lot N .... --•-•----- ........:........... .. :^............_........--- W ^Owner ''�A dress _ ..... ._.... ... .................._. ' ] .... - . ...... ....- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............?...........................Expansion Attic ( es Garbage Grinder j aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------•-------•--•-------•---•-----•-------•----------------.-----------------------._.. W Design Flow............. ....................gallons per person per day. Total daily flow..........3.2.!n....................gallons. WSeptic Tank—Liquid capacitv.00�agallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Le-gth..____._._..__.._.__ Total leaching area_.............._....sq. ft. Seepage Pit No..................... Diameter.................... Depth loin et.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin a ( y ' Percolation Test Results Performed b.:_.... ........ ..... ._:_... Date...... I '_ Test Pit No. I................min>�t'' pe iarch. Depti� of Test Pit.................... epth to ground water........................ 44 Test Pit No. 2................minut s p r epth�of Test Pit.................... Depth to ground water........................ .................. .. ............................................................. ` � D Description of it :... 4"t ,......... -•. .-L?_.Sti,?. ......................................................... V .............. � _. —.... :�•fi —.........fi..-U.�M.reh•.'�"""--••-•-- � Q n ...�------- -------------------------------- W - ---------------------/Y- -------- 5.. ...mvl.._...._....�.�.-�.-�_.......--•-------- s` �...-----------............................... 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. f Application Approved B3 ------ t f�. .F _ ... .-e Application Disapprov f or a following reasons----------------•----.....-------•---------------------••--------------------•••........... ••---•........----- ...............•-•........_----••...................•......•........----... ......----•-•--- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` . . ........... ..... Trrtif iratr laf Tuntphattrr THIS IS TO CERTIFY, Th ndividual Sewage Disposal System constructed ( r Repaired ( ) byJ.�._ C�t" ?°.... C ....--------------------------------------------------------------------------------------------------------•---...... ll Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary o e escribed in he p > y t application for Disposal Works Construction Permit No _�,.•:�y ;___________________ dated_ _ ^_..._................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU ANTEE THAT THE SYSTE� WILL FUNCTION SATISFACTORY. DATE...':........................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEALTH 1Z9 No..00.f.".... �i��r.��tt n �� �rrn�trnrtuan rrntit Permission is hereby granted................... ----••.... ........---•-------------•--......---..................----•---.. to Construct ( or Repair ( ) an In iv Sewag Disposal stem /''" _ ]� at No.•-•-••..... Si--sir........._.. x...... �.: - V ..........`' `...,,3! z `-......' Street ;.' as shown oZhe plica ' n for Disposal Works Construction Permit No..................... Da �.�-.-...-.... ----------------------- ------- ------ i ... l o .. ..... ........... alth DATE ....----•-------...•••...._......•••............ FORM 1 55 A. M. SULKIN, INC., BOSTON 51NGLt- FAMILY - B�ORQoM (l W;G R GABAGE G W NDEs2 pta►1-Y C1.Ow A 110 X 3 ' 3�QG.Pp � 1!/ �•r�{Y r SEPTIC. 'T?:WK = Z30xl5o'/• �956.P. o •; , �'` fir` ` u5E 1000 GAL. ► � �/ . + r ' ' G 1 D o v AL- 's►DG.WA�L ARGA = 15o S•�F � t 1 I F„�'' I %50 5.F xG.p`o �,I ��� �� BOTTOM laREA° » Yo �F•- -/� �� ,12 D $NSF/ y % . �'` 1 30 -ToTA" c�.516a * .¢25 -TaTA1.. pA[�-Y F�-o� � 33o�•Pg �w �i ,/ ii� /���- o `,x � ;° � s 1.. � ,,�,� ; ; PEwcot.aTloN p-ATEs I Im ZA1N oP Ll~55 � :,j �� �� � ;a`f T �tN Of ESN OF fi4�sp �A '�f -40ALAN �. 1 RICHARD W. mP3 JONES BAXTER y h •� �' \01 Na 24048 p 25100 hp ARV 1 s TOP FWD$ HOLE //e z.. 410 ,coAMd` loot/ _ INv. `3/•G ! INS. c41.. 39 ¢ �avP�c ,00o INS 3y'Z GQ4✓� LEACH 3$. • . a ' ; rJ • P I T INV.. INV. wI-ru _ 38•go ' 39 0 WASKGD ,S.9i✓Z� 61ToN6 GEwTIF•I ram p PL.oT PI..A.W .,Va o1,47 PR.OFILtr �pCA-t1oN 49.5 Wo• 5CkLL- SCALE ►"=�oQ� ..� p��i-I4I83 REP swam GE I % G E a•('1 F Y -T H AT T N T 1= u 4:5 0 wN - y{�.R6o 1�1 GOMC�I.Y 5 y,►lTµ•THE �,1 cE�IN E -T- A vi P 5L-*T5 .GK 9.,6.4Pu19-eASWMI -TOWN OF AN-D 14�-, K(07— �-•G• 3 j 5�(-8� L.OGATED WITNIIJ TN6 GL.odS7 PLAIN ( j BAxTEiGe tJ`(E INC•' • REG 1 S'T�Qs►v'L.A14 o 5 u r-v RYceS Tu15 PL 6-KI If) NOT ca AN osTEQ.VII.I.�• • MASS. • IM,5TRuMr--Nl- 5uevGY -T VAS C)r- T5 Sucuo �+ M . NoT DC- V�L' ��TC► C�C'r[:.t• 1►-IC L.nt' 1-IIaG�� APPL- IAA► r �.Mi!'J K.J' '�ITN