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Home My WebLink About0537 LUMBERT MILL ROAD - Health 537 LUMBERT MILL ROAD Centerville .A = 146 — 097 0 /// S I No.2•153LOR UPC IUU .mead=n * Me&In Use► . roAl =Mumma= 01H mm ' i a No. Fss...... �!5.... THE COMMONWEALTH OF MASSACHUSETTS 53 `� BOAR® OF HEALTH o �--�— i .................. ........................OF..........................................---.-----------------------..................... ,Z ppliration for Dhip iial Works C onstrurtion Frratit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sstem at* ..................... .............. ....... L on Address or t n A n p ' caner ddress a •---.. .. --- . .. ..... ....--- ------------- ------ ---------- T - ---- ---- ............................ I st er Address An Type of Building Size Lot...t!'_�C--Dwelling—No. of Bedrooms.... ....._.i! --------------------Expansion Attic ( ) Garbage der (/VQ P4 Other—Type of Building .Li2U(2_e------------ No. of persons..-.�--------------- Showers Cafeteria ( ) a4 Other fixtures ................................. -------- aDesign Flow..55.... .. ......gallons per person per day. Total daily flow.......... Ld lons. WSeptic Tank—Liquid capacity_l.`- 0.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.__.._...._-.... sq. ft. Seepage Pit No .Lon-_._-__-- Diameter.......!P._..... Depth below inlet......6......... Total leaching area-.��...sq. ft. Z Other Distribution box �/,) Dosing tank ( ) W Percolation Test Results Performed by.�* .+1 V.t..P.. t2L.!NU!r.. Date...... r,.......... .Test Pit No. 1......��n...minutes per inch Depth of �est Pit........14....... Depth to ground water....... .—........ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 ---•---------------------------•--•----•-- --..--...i / ..... Description of Soil---Q..-.a-...._. .......g__ ...7.........C� ......� 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 TITL% 5 of the State Sa ' ry C e— The ndersigned further agrees not to place the system in operation until a Certificate of Compliance h s s by th board of h alth. ...0.... , Date ApplicationApproved By................................ ....... ....... .. ............................ ...................................9 " Date Application Disapproved for the following reasons:...........................•---------------------------•------•-----------------•--•--------------------.------ ......................................•....-•----------------.._...........--------•----•-------..........--.......-----•-----------------...-•---------•-•----------......-••----------•-------•--•---- Date Permit No. Y .` .. .. __ .. Issued........................................................ ---------------- -'--------Date ---- - - THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH .......... � iv5 cL 1�.... O F................................. ................................................. 01rrtif irtt#r o,f Tomphanrr THIS- - ERTIFY, That t e Individual-Sewage Disposal System constructed (` Repaired ( ) by ........ - :............................' 1�'T_� ........ " -""--"..........--•.....................•---..........----•----................ ......._ at �_ a.a.. a .._...... ----•-•-----"-".............•---•----.. ..------............ has been installed in accordance with the provisions of TITf �e,Sanitary Cade de r in the application for Disposal Works Construction Permit No......................................... dated..............�.....7.. ........... THE ISSUANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL U C N SATISFACTORY. DATE....... .. --------•---•---------------- Inspector.......:_._._..1..." ............................................................ !� THE COMMONWEALTH OF MASSACHUSETTS �--- BOARD OF HEALTH etc? �s c .............. � No......................... Fn........................ �i �ru tt1 ur�u ( rtlifrur.flun rani# Permission is her by granted..... `a'�....:ArAt .----•.•-- ..._.___---•..........................................................._ to Construct ( r Repair ( ) an Individual Sewage isposal S stem at No.........p� <<L Corte Street z: 1 ' " f ^ w as shown on the application for Disposal Works Construe .. o. Dated..-"-"-".................................. ......................................•---•-_._....____......_--•--•...••-•-•-•-••---•................._ ' 1113 Board of.Health DATE....--""""--"-... ---•-"-""----"•-".................•---..... - ........ t FORM 1255 A. M. SULKIN, INC.. BOSTON No............... . �. Fus.....----�SaA? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................................----.....OF......................................-----.......-..-..-..........-......_.._.. ..... Appliratinn for Disposal Works Tonotrnrtiun "prrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....:...........»_.............................................................................. -••••....---••------._.............---•••----•--......................................___-__..._. Location-Address or Lot No. W .......................»... ..........._.Owner •• ^_.... » —..._..................»»......----•-- -------------- - ...... .......... .........._............. p� Installer Address U Type of Building Size Lot.... ...)kS t .-� Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) 4 Other—T e of Building a Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ..... W Design Flow..55................... :....__gallons per person per day. Total daily flow.....__......__...___............_.___......gal lons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Dept h................ x Disposal Trench—No...............:..... Width.................... Total Length.................... Total leaching area..............,....sq. ft. Seepage Pit No......Z........... Diameter......./_1?...... Depth below inlet......;e......... Total leaching area--- :...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) fM aPercolation Test Results Performed by � y_ _��.��" [`:. 1j 1�?!�!..1 ,�.- Date...... ::.t,: ::iw? .......... Test Pit No. I................minutes per inch Depth of Test Pit........ :___... Depth to ground water...-�t�...... . 44 Test Pit No. 2..............:.minutes.per inch Depth of Test Pit.................... Depth to ground water........................ 0 a -------------------------------- ---------- ............_.... -- ...... ............_... Description of Soil.........................................................•............ ... .... x .._..•....................•--••••...............................--•........._......---.....•------•••--•••••-•••-•-•-••----••---•-...._.._--_.._ ....••-...-----......_...............-•--•--••---••- w ----------------------------------•--••-•--••-•-•-••--•-••-•---•--••••••--•-•--•••••-------•--••-•---•••-••....•----••----••...•--••--.._..---...••-•....-•--........•••--••••----•-••---------•----•-.. V 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 h th. -= igited.... .... ................... .......................... Dale Application Approved By-•• -•........ ....... � ....... ..-•----••-•---••. .................................... --•----^---•-•--•- Date Application Disapproved for the following reasons:............................ ----••--»»» --------------------•---•-----------..........-------..._._..---...-------....._...._...------.............._..-•-----.......--•------------------.....----....-•---------------....__...-•-•---••---•-- Permit No................... ..�`�:....-��- » Issued....... ...........•-•---......._....»D�._.... Date I � Of SN �qS,p c, RICHARD - PETER �N A. o SULLIVAN BAXTER yr� " No.29733 -4 No.24046 �FV'tET I�a aApOpg�Cis1 fsS/OVAL • � �� '�. 'TL S—ALL �/�`7�'v ��-C---�� '�"�'_2 tc/ELt. 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