HomeMy WebLinkAbout0182 TROUT BROOK ROAD - Health
LOCATION SEWAGE PERMIT NO.
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VILLAGE
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INSTA LLER'S NAME & ADDRESS
B UI:IDE R OR OWNER
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DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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......................... FRim ............
THE COMMONWEALTH OF-MASSACHUSETTS
BOARD OF., HIEALTF.,�
..OF..............
Appliration -for 13iiyofial WorksTomitrurtion Vrruiit
Application is .hereby'made for a Permit to Construct (�/) or Repair an Individual Sewage/ispDosal
System at:
�R .0... 8. ..........COTV!T.............. ....................................................R...........................................
Ed _k Lo or Lot 0
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........................ . ....reas.Qg.......................... ..................................................................................................
Owner Address
...... .. .........
Installer Address
Type of Buildi Size Lot----------------------------Sq. feet
U
DwellingyNo. of Bedrooms.____ ---------------------------------Expansion Attic Garbage Grinder (Alo
44 Other—Type of Building ---------------------------- No. of persons..__._..___.........._...... Showers Cafeteria
04 Other fixtures ......... .................................................................... ----------------------------------------------------------------------
Design Flow............J.'V........................gallons per person per day. Total daily flow--------A --------------------------gallons.
IY4 Septic Tank t Liquid capacityl gallons Length.___._.......... Width................ Diameter................ Depth--- ------_---
Disposal Trench—No Width--------------------iT otal Length_�----------------_ Total leaching area--------------------sq. f t.
Seepage Pit No..____---- --------- Diameter./ 0.g.dAeth below inlet_......._.. ....... Total leaching area.-_-.--__.....-sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) .0 A� e �%— S — .2 ?— 7-7
Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
�_l
Test Pit No. 1................minutesperinch Depth of Test Pit..-___.____-__-___-- Depth to ground water......--._...-.-_------.
44 Test Pit No. 2................minutes per inch Depth of Test Pit_._______-_-_-_____- Depth to ground water__._.__..-_______.__---.
I ------------------------ ........ ---- -- -
0 -------------------------------7----5------x�-—----- --------------- --
- -&...........7. ---- -- ..... - --------
Description of Soil---------- V V
x
U
---------------......------------------- ....................................................................................................................................................
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 be i sued by/Ce' oard of health.
gnd. -• ........ ................. ........................................... ----- 3 77------
Date
Application Approved By........... �v'w �i-1.:` ` `` _<
----------------
Application Disapproved for the following reasons:._.__._..__
-------------------------•----------•--------------------------- ................Date....................
. ........................................................................................................................------------------------------- I__J�a-t_e
--------- -
•
Permit No......................................................... Issued.......I--------------- ... ........ ...........
Date
---------------------------------------—----------------------------------------------------------------------------
No.. .............. F :: ...........
---- THE COMMONWEALTH OF MASSACHUSETTS
t' BOARD OF HEALT
Application,
is hereby-,,'made for a Permit to Construct fey) or, Repair ( ) an Individual .Sewage Disposal
Y
rtN -=
Lo o ddress or Lot No.
Owner Address
Installer Address
UType of Buildin Size Lot............................Sq. feet
Dwellin NO. of Bedrooms----- ---------------------------Expansion Attic Garbage Grinder
pi Other—Type of Building ------------------d-----.--- No. of persons----------------------------- Showers ( ) — Cafeteria ( )
aQ.:- ':.===- Mons P ...............--•--•-••------------- -----------•-•--•----------------:------••- ••--------
P Other fixtures .............................................
W Design Flow.. ......... • � __gallons p Length pet-son day.Width al daily-f1011iametAe�_......____ Depth---gallons.
Septic "I'ink Liquid capacity g a
x Disposal Trench—No __•--- Width---- --------- -/Total Length------_--_--__---. Total leaching area.-_.- -_--.____-_sq. ft.
Seepage Pit No_____________________ Diameter_ .. Depth below inlet. ______h
Tot_qj l�ailigrea.____.___._.__..sq. ft.
z Other Distribution box ( ) Dosing tank ( ) D " ✓�L - X ' ;7-'
Percolation Test Results Performed by------ -------------•--------------•-•••--•----•...----•---------•---... Date---------------------------------------
Test Pit No. L_______________minutes per inch Depth of"'Test Pit_.._.______---_••--. Depth to ground water._....___-_--.--._ --
4, Test Pit- No. 2................minutes per inch Depth of Test Pita.---_-_________---- Depth-to:ground water-__-__--_--.-_.--_--
D Description of Soil ="' ��' �"�+ f `-�
--- .v -,/4 e
ff'�
-- .--- - - ------------->-----------------••--•-------•-------------------•------•--------------------•---------------••-:---•--------------------------- ----•-----------
UNature of Repair..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 be i�i sued by e oard of health.
gn'd 3
= - -- ---
�_
Application Approved By ---------- '-----" -- "
------
Application Di approved for the f ollozing reasons- ------ ---------------•-•-•-----------------------------------------------------,
--------------------------------------------•__-_______..•--._______- ........................
w Date
PermitNo........................................-................ Issued-------------------------------=-----••----------•----
Date
i THE C-9MMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
..... OF............
�...
011ler#ifiratr of Tomplian r
THIS IS T,0 CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
g P �' ( ) ( )
by -• -- - -------•-- ----------- --- ------------. -- ..... -----•----------
alter
at..Ggr 0� „ ' '--� ------------------
has been installed in accordance with the provisions of A 1 XI of The State Sanitarv.Code,'as described in the
te
application for Disposal Works Construction Permit No..- ._._ _lklt.............. dated.... � ::.._ 7----7 _._.___---_-_-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
,S1rsT1_M' WILL UNCTjON YTTIISFACTORY.
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DATE................................................................................. Inspector -'-=- ------
cs`
' THE COMMONWEALTH OF MASSACHUSETTS ,
BOARD O HEALTH
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N FEE . `
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Permts�iori-< reby granted. . ------ •------ ------- ------ --- - ---
�'to Constrct or y'Rea n ideal: a e sposal S e
f
St eet 3- w -
as shown on the application for Disposal Works Construction P to
No. : ..._ ._____jf111Dated------ . ... .----r-------------------------------------
r.{B and of Health
DATE. ---------- --------------
'sRM F`i>55„ HOBB'S.-& WARREN. INC.: -PUBLISHERS
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