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Home My WebLink About0171 TROUT BROOK ROAD - Health 2;2-- Cq3 or THE COMMONWEALTH OF MASSACHUSETTS l� BOARD E, H 7, --p-- --------OF........ . �7.................. Avvliratiun -fur M,ivuutt1 Warks Towitrurtiou Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ U ----••-----------•---------•• ................••---•----•-••-•--•••---- Location-Address or Lot No. _ ..........................S �1 F.....� Lf�' S.............. ......................................P.K. _X..L' e._�c y...._.II I ......... Own r Address Installer Address vType of Building 2 Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder qy(f aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------•-------- -----•--•------------------------------•-•------------- •-------------------------------- W Design Flow............................................gallons per person per day. Total daily flow------------- __. ��................gallons. WSeptic Tank�Liquid capacity-----[__ allons Length................ Width_.....---.__.. Diameter-.-------------- Depth---.-----.------ x Disposal Trench—No- -------------------- Wi th...........-------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------- --------- Diameter.L�KK _" pth below ' let..... _ .......... . Total leaching area.--_-.- -.--- -.sq. ft. �17 Other Distribution box ( ) Dosing tank ( ) 0 - '49 "3•- 7 6 a Percolation Test Results Performed by.......................................................................... Date--------------------------- ----------- Test Pit No. 1----------------minutes per inch Depth of "Pest 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------ - -- ` =•-- Cxj - �� ---- ••---�y:---••--•-- .L•• W. ------------------------------------- ----•-.-------------------- V Nature of Repairs or Alterations—Answer when applicable..----------------------------------------------------------------- ----------I................ -•-----------------•-------••----•----------------------------.----•--•----------------------•--•----------------------------.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee t ued by the bo�"'d /health. fy��. Dat1 Application Approved By---�/ -�� -- - ------ '2 --- -- --- � - --- e=7 t Date Application Disapproved for the following reasons------------------------------------- --- ------------------------•-.-------------------•-•••------•-•-••.... --------------------------------------------------------------------------------------------------------•--•-•--••-•--------------••-•-•••••------•-•--•------------•----------------••-•-•------------- Date PermitNo......................................................... Issued....................................................... Date No....... I THE COMMONWEALTH OF MASSACHUSETTS BOARD 011t H-EALTH 2-1 OF........ ................. Aplifiration -for Uhipoiiat Workii TonMrurfiou Vanift Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: J .................................................................................................. ................................................................................................. Location-Address or Lot No. r ............................................................. .............. .......................................L'� ......................... ......!�"/.............. Owner Address /V,ro V Installer Address Type of Building Size Lot..._ ........Sq. feet U Dwelling L."—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder aOther—Type of Building ---------------------------- No. of persons.---_-_---__---___--_-----_- Showers Cafeteria Otherfixtures -------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............ -a......................gallons per person per day. Total daily flow--------------- ---------_-----gallons. W p --- --- --- 9 Septic Tank!-Liquid capacity.---!_!_ 'gallons Length................ Width_..._........... Diameter_-_-....-.._--_- Depth._.._._._------- Disposal Trench—No. .................... Width-_-----_-----_.--_-- Total Length__..........._._.... Total leaching area--------------------sq. ft. Seepage Pit No..........t--------- Diameter-Z-V-.--.c-.':''Depth below inlet.................... Total leaching area------------------scl. ft. Other Distribution box Dosing tank Aki Percolation Test Results Performed by------................................................................... Date------------------------------------ Test Pit No. I................minutes per inch Depth of Test Pit._..._.............. Depth to -round water.-.-_-_---.--_---.------ , Ci, Test Pit No. 2................minutes per inch Depth of Test Pit......_............. Depth to ground water.-.-_.__-.---__----..___ P4 --------------------------------- ........---az:-................................................ 0 Description of Soil------/.c. .............��2(.........Z -........................ ,f--- , ------ ------_--C--------- ...... ----------------------- ---- U ----------------------------I-------------- . ........ ------ ------- --------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI 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 boa?d of health. Signed-------)............... _./�, / -//"/> ......................................... ------------------------------ -7 Date Application Approved By------ ..................... ............... Date Application Disapproved for the following reasons:................................. f ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,,,.,O-F HEALT-H ...........OF.... ....... 4 .............. ................... THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed Kor Repaired by.......... ........6745i....1%� \"I ..... . ............................&................ Installer at -- ----------X ------------_-- I �-_V -----------Z.;)- ------------ ----------------------------------- Z ---------------- has been installed in accordance with the provisions of A fir�,.e XI of The State Sanitary Code as described in the -------------------------- --- ----------- application for Disposal Works Construction Permit No___________________ t//------ dated / //- /2 - -7--4 THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------/0-----------.... -------_----,2 --------- .... .................... Inspector-----------0-- - ----------- .................... THE COMMONWEALTH OF MASSACHUSETTS HEALTH -7� BOARD 0 ...........OF.... NO..... .... FEE. ............ Permission&_h,@re_b_ygranted IV -----------_--------- ................ .. ..... i"d'granted i-vidual----. ons'�ruct or Repair -------�/wa,-x to C S. wade_ Sy t 7/ --------------------------------------- t I K. at No. Street as shown on the application for Disposal Works Construction Pi,?rmit Dated-: ---------------------- DATE................................................................................ Board of Health FORM 1255 H0813S & WARREN. INC.. PUBLISHERS r .i„ - 1 sr i v `•� re-•Y 9a q-s' t5"» ��` .R k 4 M. � Y i SAT �NV ' ty � •` . God tt P. � r' Ql- / k t $ r fir+ •. � �� . � s " � �� 4�5� .�� Gee /3�: .'� +� $ �•� y Ra : arc h - I. s>„ ✓, f - ,G.pc is q.rr fir.. Plot � Z4 .��F��'e6G/CE: � �00 OlJ•�r G �",��i'�'-/ems �� ' r '° �r- Go 7T L� �Ii /.�.....C�v,y .. •f x ,,� A ,rp�.4i �,",h4 ;' 'j`{ i §:. _ � r.G./�J//G 7./'��!•'9'" ��Gw^t''..T �y�f.F x,�nR;, �+ri - 4 /C5;r ;: b J <. at.Y. 1 .iN^^'�✓ a i "( j$` r 3411 _ t xr . 'aeeOe)-' C��'T/FY 7/"sa7- Ti/a ®y/A.D/4/4� ,�ri:9.s'.4� K � V.V A-e6 `'OA-' y►�/s .OL.oQi4/ /S 40CRrta Oa% .T/dE . _; � 1 ,VO ,9a .VjWO W.V'NO.geO/V Li.V a .,7 iNAT: /T ? �ZH {)f �:�,�+` �, r f nr GS COIL/F04../1/c� . 710 TN �OI<J�IL! •y' •�� ''rW. �I Icte� cOAIS7' c.1C . ARNL v .- TE a p a hs" t ' v i, "An 4C47 k C'/V/'L 46A/G/tt/,PEGS r' LA�✓a 3CJBV6YO B3 r LOtJTE `6A^-`,�.*`MIOG/TH, MASS. ram- L ar s^ �y✓�w�'o ��$� .' DOWN CAPE ENGINEERING DATE /0� ;Z JO�>a Piccadilly Square Rt. 6A Yarmouth, Mass. 02675 PROJEC .� !`-57 1,171�z :iF- Phone 362-4541 LOCATION vv /Zao leo CONTRACTOR OWNER TOSO/ p WEATHER TEMP. O at AM Cp C �fgi�S/ oat PM PRESENT AT SITE 77 THE FOLLOWING WAS NOTED: cro i COPIES TO Uji� D SIGNED FORM 2•1 T®TOWNSEND. MASS. LOC&TIOt�l ' 5EWiiC.4E PERMIT UO. 'VILLAGE INSTQLLER5 IJWE tt' ADDRESS DUILDER 5 Q / MF- &DORE SS e114 DIaTE PERMIT ISSUED — i r DATE COMPLI &MCE ISSUED ; i � 1 v t E i I