The URL can be used to link to this page

Home My WebLink About1103 BUMPS RIVER ROAD - Health ► W By*ps- River 9 D Cetrv-r v;ile l g g - Oqq S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLEFORESM MIN.RECYCLED INITIATIVE CONTENT10%® Cenified Fiber sourcing POST-CONSUMER wwwsfipropra.rp SFW12y0 MADE W USA GET ORGANIZED AT SMEAD.CQM LOC TION OSWAGE PERMIT NO. 160M e �e VILLAGE NST LLER'S NAME i ADDRESS C e UILDE R • OR _OWNER_ DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �`�� Y. Kit � V41, �yl�y .r( �fjJ�WIa 4 ` Ih z T,HE COM;M;ONWEALTWOF MASSACHUSETTS 3 {� ABOARD OF HEALTH 4 1 „ OF. �.�� Ya n ................ .............. «;w.p ..... .. ......B�::.��_: .... THIS IS TO CERTIFY,`Jhat the'-Individual Sewage Disposal System constructed' ( ) or .Repair'•edj;( Installer wy il 'i. £? t�?£� 3P �.E' `�t �. t28�311 •.. '� .`'------ +hxs been installed in accordance twi.th'the provisions of TITLE, j of The State Sanitary Code as'.'descrtbed in)the i # 'rappl nation for Disposal Works Construction Permit No_____________________________ t: dated_...._ _.. ._.___. THE ISSUANCE OF THISr CSRTIFIC ATE SHALL NOT BE CONSTRVED AS A GUARANTEE�THAT',,THE {SYSTEM* WIL FUNC N SATISFACTORY. ' w, pATE. G......... d} {--� - Inspector -•----•---------- - ,�i` �" y e, THE COMMONWEALTH OF MASSACHUSET.,TS u. BOARD OF HEALTH r n N .......... ..... FEE...... .fl Permission is hereby granted ► Ma 'frn- _.E__....-_ fo(Construct-(" ) or Repair (z an Jndiv�dual Sewage Disposal System at�No� °M1 �r�'X' ........................` _-•• --•-••-•-•-•-- 3111lt'L� ... ` ,^� e :,: L .�•,. r Street dZ_ M as shown on the application for Disposal `l orks Construction Per o__- _f_/:w.______ Dated___ ____ _____ __ s > r Board of Health DATE `-- ` _° -------- «- & WARREN IN6 PUBLISHERS FORM— Ii55.,,HOBBS kt 7a_s-73 FEB...8,2 ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..........-o F.......Barns tab- •1e -- --------------------------------•--------......... Appliration for Bhipoii al Works Tomitrnrtinn umi# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 1103 Bumps River Road ••--•-------...._--------------------------------------------•--•-----...................--•••--- --••---•----•-----------...-•-•----•-----------•-----------....................................--- Louis Bushnei1ation-Address Centerville�...or Lot No. .-•--•--...................... .......---------..............---••--•----•---- --•-•-----------------------•-....... ....-----.............................................. Owner Address ....Zoaeph...P-----Maooiber---&..Ban---Ina.............. .....Centerville............................................................. Installer Address PQ Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...---.-----.........--..... Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow...........................................gallons per person per day. Total daily flow...............................:............gallons. WSeptic 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 ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit---........--....... Depth to ground water-...-.-.-----------....- G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-----------------------------------•--------------•............ ...---------------------------------•----------------------------------------- .....---------- 0 Description of Soil........Sand & Gravel ----------•••••-•--•••---------------•---••-•--...---•--•--•.••-•-•-------•-------•--------•-•-••--•---•---•----•••--•--•••--•--•--•---•-----•------. x W ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------•------------------------ UNature of Repairs or Alterations—Answer when applicable.....:1-19.QQ---ga,11Qn---Qve.rUst............................ .................--.................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT :; p of the State Sanitary C- e— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the b and f 1 lth. /te Signe '' :. � Application Approved B ....... y� . ............ ..... .,�� ' ....--••- •--•- 7� Date Application Disapproved for the following reasons:.........-------•-----•----•------•----•---•-•-•--•--•.................................•--- ............. -----------------------------•••......•--.............--•••-------------------•••.........••-•------•----•----•••-•--...•-••-•-•--•--•-••----•-•-•-------------•------••......---•---••----••-....----- Date PermitNo......................................................... Issued....................................................... Date w / i No................-....... Fims...$5•.Q6...... THE COMMONWEALTH OF MASSACHUSETTS .5, E ' 'BOARD OF HEALTH" 'v.;m...........O F.......33a,rn S ish xe--------------------------------------------------- Application is hereby made for a`Permit to Construct ( ) of Repair '(X ) an Individual `Sewage Disposal S 1 9 v .."� ,�,"'_:l a 1p ---xi•-tr .. _�T'. � r ....................................................... i t C Y�� '`Location-Address ¢ t� tY or Lot No. '.....Ti��J.� ......... ............................... ......lR'',`.b P. '.a. _�-0�R........................................................... Owner Address f .... ... Address r a; Q ° Type of Building r Size Lot....................... ....Sq..feet aa yx �;Dwellirig—No. of Bedrooms ........................Expansion Attic, ( ) Garbage-Grinder A( ) Other Type of Building; No. of persons_ >,. Showers ( ) Cafeterias ti 1 „Other fixtures .`>, i -- ---------------------------•------ ................�2ri_: d -------•--•-•. ,..... W m Design Flow ............................ gallons;per person per day. Total dailyRflow_____.._____.___.._ ,galons. Wept1c Tank,=Liquid capacity r ' gallons Length________________ Width £ i : Diameter._._._ DepthY$._ x Disposal Trench—No............ t __:,Width. .............. Total Length......._ .. Total leaching area.::_ s,_ tsq. ft. �Seepage Pit No-•------------------ Diameter. __...___._____.. Depth below inlet :: Total leaching area.. .... sq. ft. z Other Distribution box ( ) Dosing tank ( ) ,Percolation-Test Results Performed by..................................... ........._.. Date......... .Nest.Pit No. 1................minutesper inch Depth of Test Pit Depth to ground water -------- (s, k :Test,Pit,No. 2________________nurzutes:per inch Depth of Test Pit --._------ :,-Depth to ground water . t .......................... Descrptioo Soil ! .7 _.......�.. -------------------- • ' ' - ...._... . \-. i 4... T' U Nature of Repairs or Alteration's--Answer;when applicable.__.._ �!If1as� t r1__. t3�?_l�'!'.� 2= .'__ f':__._.. Agreement ;The undersigned agrees to install the;aforedescribed Individual Sewage'Disposal System 1: ' accordance with ,the provision of LIT?.;;. : �y eii l p,r, 5 of,tie State Sa�fary,Code—The undersigned fur 1 er agrees not to place the system in ` ;,operation until a Certificate of Compliance`has een ssded by the board f 1�ealth. YL +q 4^n- ,G r r y4fi y'Y 95./ " ". 'Y�,+'�' ^+l .6t. S.0 T.1._. }� Signed '..... � r Date Application Approved By...... r . r�L.. •. " +� ' .�--- - try Date Application Disapproved for the,f ollowing reasons: ............ z .. s <. Date N Perm it No.................. Issued....................................... Date n