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HomeMy WebLinkAbout0020 LUMBERT MILL ROAD - Health 20 Lumbert Mill Road Centerville A= 168-099 K M E A©� No.2-153LOR UPC 12SU smssd.com • Made In USA �,*CrCL4 1�lA�M 11�I�OIKT l�E IF �� XQUEUM .,No.. :- ... Fps....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO.vK, 0................OF........ . .. . _-X..�._..t ..................... Appfiration for Diipnsal Works C outitrur#inn ramit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at •-•----------------�. --- 7..----•------------------..............---••- --ation-Address ...or.Lot-No........................................................: .'.._.�':�... t.r ..................................... --•-••-•----........................... .... ^], Owner ---•............................Address a .. ......... tr'•'------------------- i'er........--•-•--•--•----------•-------•-•- •-----.-•-- -.------•--•-••-•-• ................... Instal_er Address Type of Building Size Lot..._..� ..Sq. jeet U Dwelling—No. of Bedrooms_._.... --------------------------------Expansion Attic ( Garbage Grinder '4 Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ......................... W Design Flow...........��...._...._.__._._gallons per person per day. Total dPily flow....._��,.0.....................gallons. WSeptic Tank—Liquid capacity.!_ Ions Length—(Z>.... Width._ .,b--.. Diameter................ Depth. .._. x Disposal Trench—No. .................... Width__....._._.._._.___ Total Length.....____ _ Total leaching area_____._____..------sq. ft. Seepage Pit No--------------------- Diameter..... De th below inlet_.... ......_. Total leaching area_ .....sq. ft. Z Other Distribution box Dos' nk ( / Percolation Test Results Performed by K. _. -� .......... Date.. _A%—, _--__. a Test Pit No. 1--� _-_ p p p ground� minutes per inch Depth of Test Pit..._..��-_____ Depth to ound water_. f14 Test Pit No. 2..�.�._minutes per inch Depth of Test Pit...... ,__.._ Depth to ground wate .__ e-i ------•----------------------• •. .. --••- ••--............---...... O Description of l `'�- -- �... �_�- �(eo. \ ... 'G\7.......-•---------------- x � _ . . U •--•-------------- -••--•-•----•-••--••------•-----•--------•----•----•••-•••-•--•-• . ••--...---------••--•••-•------•--•.. VW ---••-•----•-----------------•--•••-•-•--•--•------••--•-•••-----•-••--•-•-•--•-----•-•.....-•---•-----•-•-••-•---------------•------••-•--•----•---...-•-•-•------...---••-•-•-••••-•••....-•-......... 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 ertifi to of Compliance has bee by th rd of health. r-" ✓ Signed .. 1 = --•--•------------•- I � r D e ApplicationApproved By...........:.................................................................................... --•----.................71� Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------•-•-- .....................•-•..........-•---•••--•-•----•-----•--•---•--••--•••...---------.........----••••--...••-•----•--•-•---•--••-•--•-••-------------•----. ........................................... Permit No...\��r q V -------•--------•-. Issued---------------------------------•----•---Date. Date w�` •i�To. _ -- f FxB.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -...............OF...-..--"' ,%.+A: .��.-1 - .................... Appliratiun for Disposal Works Tonstxnrtiun Frrutit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal vtem at: V_'(3 EIZT- e LA- a h;ZS_k?1105 HILO, --------------------L0.r...-7---•---------------•-------.......---------- o tion-Address or Lot No. oM3 W Owner Address ,.a • C• . � Installer Address ���'�1+--� d Type of Building Size Lot..............-_7_`_.____'�-.__/...Sq. et Dwelling—No. of Bedrooms........ ...............................Expansion Attic ( U Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ---------------------------------------------------------•-•----------•------- .. x Deign Flow______.__ _ _P.................... allons per persone ay. Total dc§ily flow____........�..�...................gallons. Septic Tank—Liquid*ca acit __ . Ions Length_�, _�___ Width..5. .. Diameter._ _ _. De th__ _ ¢W _-- 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 l 7 ES Dosing nk . a Percolation Test Results Performed by....1­4 . A k.l.,_,:r�t... 24C ( C .._ /( �946�_..-_.... _ Date. Test Pit No. I...�-2_._ P 1`--- pp g minutes per inch Depth of Test Pit...__.__. ---____ Depth to round water___ _.:©:+__�staC;CX..xJ1�fL� fZq Test Pit No. 2....4.'?.minutes per inch Depth of Test Pit.......... ..... Depth to round water....___..�'.►�YA#-CMiZZ- x .....................•------•-•••- - -...----------------------------------.......... O Description of o 1. '�--• - -.6 (.---•--2--\.._ c. ------------------------ W -------------------------------------•------------------•----------------------------------..••.-----------••-•--------•-•----....-•-•---•---.......------------------.........-------•--•....._------ 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 TITI.Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until L"ertifi e of Compliance has bee sued by theLoald`of health. d Signed. ! " .�-mot.)µ ` r ApplicationApproved By-•----- ._.... ---•---• -------------••-•--------•-•--•--------------..._•--•---------•- ------ � Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------- ------------------------------'----------------------------------•---•---•--•---•--.•--------•-----.•-----Date---•--•------- - Permit No--------------------------..- -----------•----- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH ............OF...... . ...... ..... � .. ............. Tbrrtifiratr of Tout rlianre T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by --- -••-----•-•...............................•••••-•--------•------•----•••-------••-.........---------•-•--•---------._......-----------------....._......:-••••---_-- _ O ✓ �' Install,. A --------- '" 1 Y', I I V1 IV1 at.--- ------------------------------ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as 4escribed in the application for Disposal Works Construction Permit No------- ""I........ dated.....-----0--�::I`----- A,.1•'�_l�5 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. } DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BQ:(R F HEALTH ........ .................. ............ - 60 - No.`...:�.............. FEE`'' .............. m uPermission is hereby granted------. c--------------------------•---•-•----...--•----•-------•....•---•---•--•--•-•-.......-----........._..........••••. to Construrtj� ) or Re air ( ) an Indigvi�d�1j 1 Se age Die7�osal System atNo.. -------- ...........................................................••--•--.•-----------------•------•-•--•---•-•---•------•-••-----------•--•-----•......••---•••-•-•••••- Street as shown on the a plication for Disposal Works Construction Permit No......•...."y yy Dated.___ °_.__:_. _ q ................•---------------------------------------------------------------------...--•••-----•-_.. l Board of Health DATE......... .......... .........-•---�.......... -----------•---- FORM .1255 WARREN. INC.. PUBLISHERS , � © C7,) C�2- �� LOCATIOIr S, EWACE ERMIT NO. VILLAGE INST LER'SI NAME i ADDRESS 0 U I L E R d OR OWNER vko Im DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 716 �i ��I c� �� 9� No.----•-...'?yG Flm$...a�� °.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT ........... ...............OF....... - Appliration for Diap.aaal Works Tnnitrnrtion tirrmit Application is her bDmade for 9/Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at,,.( .. .. ................................................... �Lo,,at o-n,Address /_ or Lot No.,/ . e 1 c �9.14..:. ^------I•-��-t�-1[K- S�i�• •----•---------- ••--.1• 7 �.4' .b P. ..... 1.0... v.......................... Owner Address a .................... ld eili s�. -�1_C. �/.. ::.. ...------•. 1 Installer Address }� U Type of Building Size Lot../, ......Sq. feet Dwelling—No. of Bedrooms..........._.3.........................Expansion ttic ( ) Garbage Grinder (A/� Other—Type T e of Building ....... No, of persons ............... Showers � yP g --------------------- P (�)--- Cafeteria-( ) dOther fixtures ...............................-•••--••--••-•-••-•--•--••••••----••••••••-••••••••-•------•.............-----•. • ----•. w Design Flow. ................_: �.._____....___gallons per person per day. Total daily flow........�7...21d.....................gall ons. WSeptic Tank/—Liquid capacity/ all!ons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../........... Diameter.........f✓••......_ Depth below inlet.....Z.......... Total leaching area----2A.r...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - '-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit................,... Depth to ground water.---.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ra' - - ....... O Description of Soil.....�.�_. -. j -�----- ----------� �- --- -% .-.--- W ---••-••••••••...-••--•....-••-•••••-•---•-•---•••---•---••--••---•-•----••••••................••••---••••--••••-••••-•••--••---•----••----...-•-••-••=•••-...-----••-•••••-•------•-••..........----••- w VNature 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 TI:'Li:. 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. Sigd--------- --- --•--------------•-----------------•-•----•----------•---- ........ Date Application Approved By....... lrit� Dat Application Disapproved for the following reasons: ---------------------------------------------------•-----------------............................. - - •-- Date Permit No................ ..-. /A� I ued Dater� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF-, HEALTH .......... !� �ti, _ .....OF..........�.. �...4. nl:2.�: ........................................... (Intifirate of Tontlilianrr THIS IS TO CERTIFY, That the..Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-- -- --I... ,:._r!r ---••-............................................................................................................................................... _! Installer 4�. J / / r a ^if .. _ .t�t' at... ••----. rr.,_ -------------------._:. ....--•-------...-- -- --_L ----- _ !......................................... . •-•------------ 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._. r'___�-------` _ -.__- dated-------`.................... S/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....... ���� ( c� ...:.... �..Y..... . =. 'WFE...... h E.. ........ ..."— .. 'Disposal` 10orks.,A011AInstrudion amit Permission is hereby granted-.:-- = Fr..' to Construct ( �� or Repair ( ) an Individual Sewn ge Disposal System 1 ? t— at No. s f ;;',:`..__.-->�--= - 7 � f Street as shown on the application for Disposal Works Construction Permit No---------:-/..._.... D`acted.._. ...... r'......... .. ................... j' ------------- `...!._----------•-----•-- -------------- _;. Y••............................................ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS J No. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .t r ._..--.. O F......... :..rr it..: -. ./.,e.7 -----•`............. ..................... Appliration for Uiopootal Works Tonitrnrtion reranit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ... ....................... ...............-•-------.....----........ Location Address or Lot No. ...... = i r 1, -- f ;r i--- RJ—r r t'1 ............ -� � 7 f.��.............-r;T".....!�.... — ------------•-........-•-•-- Owner Address r . !_.......... ...................................................... � r Installer Address Type of Building Size Lot..I_S r'!%-Z Sq. feet Dwelling—No. of Bedrooms............... .......Expansion Attic ( ) Garbage Grinder (k) W Other—Type of Building ............................ No. of persons........�t.............. Showers ( ) — Cafeteria ( ) d Other fixtures . .... W Design Flow..................:. .................gallons per person per day. Total daily flow........7._ t).....................gallons. tx Septic Tank,,)-Liquid capacityry�.�:j�allons Length................ Width................ Diameter................ Depth................. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No......... Diameter........-�t....... Depth below inlet..... =..-.......... Total leaching area.... .".f...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•--•.............t..........................................................I.............=..........••- �... r O Description of Soil....... -----; ...........?..- ! x ' U .................................................................................................................................................. W 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 IiTL ; p S 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...................................................................................... ................................ Date Application Approved By---.... .::...._. ... ?.±._:2aA/ .. "-`=? =-J r ' Date7- --•••----- Application Disapproved for the following reasons--------------- -_.____________..__..--.----------•--•----•----------................................. --•.....•-•---•------•-----------------•--.........------.....-•---.............-----...---•----...-•-------------------------•------------••-----------•---------------•---•-•-•---•-------••-•-------- Date PermitNo...................................................-.... Issued_....................................................... Date • � . . �� 1 1''•i"1U� 1t.'_i1J 7) 1�lciV �T�fYi'7)i'• �i..l=.lr,yy��-! •1-+fll Y � t/+ ,��r. 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