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Home My WebLink About1379 BUMPS RIVER ROAD - Health 137q BugF4 Rivcf- R� C2A ft rvi)It 18 8 - o6s S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR AINABLE FFORESSIVY MIN.RECYCLED INITIATIVE CONTENT10ek® CerdfiedcmerSourolno POST.CONSUMER —.sfipromourp SFI01290 MADE IN USA GET ORGANIZED AT SMEAD.GQM I LOCATION SEWAGE PERMIT NO. /� 79 � zm� �� !� 85 - 1/3! VILLAGE r I N S T A LLER'S NAME is ADDRESS 0 U I L D E R OR OWNER DATE PERMIT ISSUED ally,-� DAT E C 0 M P L I A N C E ISSUED I3 -77 7/, j \ - s � P R�� No.................. � Fis.. ( THE COMMONWEALTH.OF MASSACHUSETTS BOARD� ........:....../.... 1� 4 ....OF.......... ..17 ... �1.... ......................... T App iration for BiipnsFal Works Tonstrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( Z�an Individual Sewage Disposal System7 ............. . . ............ ----------------------- -•------..........._..........----------- Lo at' n-,Address or Lot No. ....��.�_........ ..,. ✓ .......................................... ------------...................................................................................... /.?.ww/ ner ... �..f�G/ Address... ......_.._.. � Installer Address UType of Building / Size Lot............................Sq. feet Dwelling_ 0. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........................--.. Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------•----•-•--......------------------•---•-----•--•-------• .............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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........--...........--. f14 Test Pit No. 2.........:......minutes per inch Depth of Test Pit.................... Depth to ground water.------.-.-.-----.-.---. ---------------------------•----------------.....--••-----......--------......................................................... 0 Description of Soil.......... ---••-----.•------------------------------------------------------------------------------------------------•-•-••....._.._........... x W ........--•-•---•-•----•••--•--••..........-•-•--•----......•••••................••..._....-•-------•••-••-•--------•---.....----•-• •••---••••----------•••••••--•-•-•---••-•---•••-•-•-•-------... x ----•••------------------------------------------••-----------------•---•.•---•--------••-••..........---•------•------ -- U Nature of Repairs or Alterations—Answer when applicable-.�.. . . ........./............................................................ .. ......•••-•--•-•-------•-••---•-••-•--•---•-•-•--•----------------•--------•-.....•-----•.....---- r Agreement: greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with / the provisions of iITI.L 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 b th bo r f health. Signed- - --- -- -•-•- •�--- -�� . ./.�,� Date Application Approved By-•-•-•-•--•--•-•................... ..._......�-z'-R-.l...�..... .............................................. Date Application Disapproved for the following reasons:..............................................................................................------------------ -•-•-•.......................................•----•--------....--•---------------...-------•--------------•••-•-•-•--•--•-••--•--•-•---••-••-----•---------•--•---•-•-•••---------••••----•---••-•-•... _ Date Permit No. `' 3�i_ ..... - . Issued - Date - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH {} (Intifaratr of Tomptiattrr T7.,,,, S jTO,C, RTIFY, T at the Indi idual Sewage Dispos4loSystem constructed ( ) or Repaired by 4- '- ✓� -- - " .... ------------- ----------- .. � � Installer •� ��/.�r -•- - -- at - t '�'`....i�`. � r'- a •---------•--------------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__`'..�."!�.�............... - application 2_:-:_1_'-___-'� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.-•.................................................................................. ,1 THE COMMONWEALTH OF MASSACHUSETTS BOARD,. QF HEALTH F J X FEE.... 1 Raposal Works Tnmitr tUan rrntit Permission ,is hereby granted:.,r f. � % r ..............� N.�?. ..�.r ,: = _='-----------... to Construct'(d {pr Repair, ) an Individual Sgm,Age Disposal Syst.� 3 at No....��.,:� ` .... . . ..-•-- ---- 1--v--- :..... Street J as shown on the application for Disposal WorksConstruction, Permit No -.!In Dated.... ?1-!' .....=. ............. Board of Health DATE.--- ..........................., ............... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - ..........��. THE COMMONWEALTH OF MASSACHUSETTS —,—. BOARD OF HEALT f tr Jt •'^ . pphratinn for Dispaii tl Works Cnnnstrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( J ) an Individual Sewage Disposal System at ........ . .....�._ Xa., .............................................. ...� ....................................... .... ..............................•---.........--- . . / Lo ddress or Lot No. /'r``� ..... } :.......... ..................................•---........---.---------....................................... .. Address a .......--•-------------------------------•- ---.....--•••••-•-•----....................._..... Installer Address i^ Type of Building Size Lot............................Sq. feet U. Dwelling o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) .�� a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•-••----------------------•--•-----------------------•-- 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 ( . ) '-4 Percolation Test Results Performed by ----------------------------------------------- Date aTest Pit No. 1................minutes per inch Depth of Test Pit.-----.............. Depth to ground water.........--............. fi Test Pit No. 2................minutes per inch Depth of Test Pit...---.............. Depth to ground water..--.................... / GY "`.......-•--------�•...............:.•--•-•--•-----•----.----------------... ODescription of Soil------.... w. .<s' -----------------------------------•--•--------------------------------•-•----------••.--------•-.----................... x --------------------------------------------------------------------------------- -----•-----------------...------------.... .................................................... U Nature of Repairs or Alterations—Answer when applicable.-. !=�-..,y—.;,- --------------------------------------------_--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?,;a. 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 br yth bo rd,of hea'lt`h.f a Signed - Ilew.f l . .. .......... Date Application Approved By. -••- U' �`' ..................................... , - Z PP PP Y --•-----•---------------------------------------- Date Application Disapproved for the following reasons:.................................................................................................................. ...............................•---•--------........---•---------•--•------------------•---...----------•I---••----------------•------...••-•-•-•---•-----------•--------•-•--••--...---.----••......---- Date Permit No....... t t 3 G'j -------------------------•-------. Issued........................................................ Date