HomeMy WebLinkAbout1302 BUMPS RIVER ROAD - Health 1302 Bumps River Road
A= 188—046—002
Centerville
/II S M EA 19®
No.2453LOR
UPC 12534
emead.00m • Made In USA
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TH0,JDMMONWEALTH OF MASSACHUSETTS /4"
a , . BOARD OF HEALTH
.......................................
Appliraa#inn for Uivpao.a1 Work TOMitrnrtiun Vamit
n is hereby made for a- Permit to Construct or Repair an Individual Sewage Disposal Applicario y ( ) p ( ) 5 ge
System at:
................___....
u.u►n ._. �.Y ....... ........ ....................................... -- `Z-
Lo ation•Ad s or Lot No.
...................... �.....- 11Gl�5 t'�TY�.,., ... ...
Owner ................................Address
Installer Address
dType of Building Size Lot---------a?.P..__._.Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (t�
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .................. ....
W Design Flow....................... .�..__: ____gallons per person per day. Total daily flow........................f� fO---------gallons.
WSeptic Tank—Liquid capacity.t� aPgallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width_____o-----------
:. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..........:Z!.... Diameter-----/0-------- Depth below inlet......6'3..... Total leaching area.4.sq. ft.
Z Other Distribution box Dosing tank ( ) ! 20-8"4
aPercolation Test Results Performed by._ f� .• ✓y _...... Date__/,/.-_ _
Test Pit No. 1----- _---minutes per inch Depth of Test Pit------- Depth to ground water.._...---..............
L=, Test Pit No. 2...... ___minutes per inch Depth of Test Pit....... �_.. Depth to ground water_-__,/.o --_-._--.
M ............................-...............................
..........
•-•-------
•-----------
-----------------•----------------------------------------------
0 Description of Soil................ ---------------- --------------•---------•---
•--------------------------------------------------------------------------------------.-----
U - --•-------------------•-----------•-•------ latCJA...
•
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 TL17PL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i s e -t e boar h th.
Signed...... '....... ................................
Date
Application Approved BY ---------_-��- z --------•------•-.----••--•--- ----- L ------
Date
Application Disapproved for the following reasons--- -----------------
.........---•-•-•---•---•-•...--••-•-•----•--•-----•-•-•••-•-•--•-••••••---••-•--•-----------••---------•--•...._....---•--••-•--•----------------....................................................
Date
PermitNo......................................................... Issued-.......................................................
Date
r
No.... .`....._' ::!6 Fmc.............................
t THE4 OMMONWEALTH OF MASSACHUSETTS +
BOARD OF HEALTH .
App trot o.� for Uhopooal Workii Tonotrurtion ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
.................._....... kh t-VE ---••---:0---•---•. --•--•----•-..._.......---••• r- � .-
LoCation-Add e s or Lot No.
--• -------•----•-••---------------•--..........._...--
Owner Address
W ---------------�. ...._.. _A_. -....._........... ......----••-•--••----•---••-•._.........--._........•-- ----•-•.........._................-•----
Installer Address
42
Type of Building Size Lot____..___?�_2U ..Sq. feet
U Dwelling—No. of Bedrooms................._____'.....................
Expansion Attic ( ) Garbage Grinder (L
Other—Type of Building _________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Pj Other fixtures .............•. •-•-••......••. ••.
w Design Flow......................ti_ ...........gallons per person per day. Total daily flow___.......__............1?tC ........gallons.
9 Septic Tank—Liquid capacity j_'u gallons Length................ Width................ Diameter---------------- Depth................
w Width..... Total Length.................... Total leaching area______.....__..._._.s ft.
x Disposal Trench—l�'o- -------------•----- i-------------- g g q•
Seepage Pit No----------2-r.... Diameter-----/0........ Depth below inlet......�_3..... Total leaching area_�z2-sq. ft.
Z Other Distribution box Dosing tank
'-' Percolation Test Results Performed by.._t."-�_ ?1?.A4_..f- ....... Date._,//.-.Z_6..0 ...........
Test Pit No. 1-----Z----minutes per inch Depth of Test Pit-------—14. Depth to ground water.......................
(i Test Pit No. 2......z'....minutes per inch Depth of Test Pit......A2:./... Depth to ground water.....l021A......
a ----•--•-•-••-•••---•-------•••••-•-•-•------•-•----•••------•---••--•-•--•.......................•..........................................................
ODescription of Soil-------------------- - --•---...---------------•----•---••-•---•---•--------------------------------------------------------------............................
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.
Signed------. k ..........................
Date
Application Approved By............ �-a.�' / '✓� .11" D"' '
• Date
Application Disapproved for the following reasons:....../-`0......................................................................................................
..........................................................................................................................................................................................•-•••-•-•------
x Date
PermitNo.....................................................----- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
J..--- BOARD OF HEALTH
............I.. ,)E fJ�J.........o F...... �: '�1,c r . rs......................�..............
VT rttfiratr of Tontphau 'r �
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b - 4.t-:- =1 `).12214T:-----•---•-----•--••----•--------------------------------------------•...........................................
1�21 Installer /)
r
-------------------------------
has been installed in accordance with the provisions of . -I "T_ j Of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... --.5` f______..__ dated----------.........•----------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................... .-.2 G ............ Inspector------------IL
+%± THE COMMONWEALTH OF MASSACHUSETTS
• _ _. BOARD OF HEALTH
......../ow/J............oF.........f' '/? i?%G. .... E;E1�
No._. ..5.2 .............. -----------......--_..
'io11ooaX loorkg T-PanfiArudion pamit
Permission is hereby granted.....1-g�lu- /"` - -
to Construct ( ✓ or Repair ( ) an Individual Sewage Disposal System
"r dirt? % t� ..
at No...._...-•••-••_.. . ........•- {� f ••. ....--••---•-•--••••-•---•----•--•------•---•--•-----•••-•----------•---•-••-------
Street
as shown on the application for Disposal Works Construction Permit No....................... Dated..........................................
�z, Z ............, .. -- -------- ------------------------------------------------------
l Board of Health
DATE.................................................................-----------
9
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ""
Y
LOCATION SE AGE PERMIT NO.
VILLAGE
INSTALLER'S NAME A ADDRESS
B U I L D E R OR OWNER
6150A 4�z ZZI
DATE PERMIT ISSUED / 22
DAT E COMPLIANCE ISSUED -�
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