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HomeMy WebLinkAbout1094 BUMPS RIVER ROAD - Health (2) �b�� Bumps �j'�� (1�.,�Q�-f . �g���� `� ` �." &- Alf 2Z No .................... THE COMMONWEALTF-i OF MASSACHUSETTS \r BOARD qF HEALTH 11.4 -----------r* ............­'_ OF...... . .......... .......................................... Appfiration for Uispv�Fal Worko Tonotrnrtinn famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locatio - r �l r t N /S -� � Owner d ss w 1�C C'�.e if ✓�. t' .. ............................... cs�.Ll 4 " Installer Address Type of Building Size Lot , .....Sq. feet aDwelling—No. of Bedrooms_______.............................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ----------------------------••-- ---------•------------- ----------------• ..__.. .......... W Design Flow____.._____/'/o__________________ ___gallons per per day. Total daily flow____._.:.___._ _____. ..........gallons. WSeptic Tank—Liquid capacity�2 .gallons Length._�'m'.__.. Width.____.✓`..____ Diameter________________ Depth._........ x Disposal Trench—No_.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... ......... Diameter._.la c ter._. Depth below inlet__- r_ '_ Total.leaching area.��� ....sq. ft. z Other Distribution box (0() Dosing tank ( ) /�'� •� �'�'''�' '~ Percolation Test Results Performed by___�aS _._.__ E____5g.M7_ ........ Date____ l_0............ Testt.Pit No. 1................minutes per inch Depth of Test Pit...................... Depth to ground water_-___-_______________--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ = ------•-•-----••----=------------•---• ......... ODescription of SoilZ 'g' fc7_.. '�'.....................................................=--------------•-----------• x �., ----------------------- ---------.......-------------------_-___------------------------------------------------------------------------___------------------------------------••-------- 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 iITI 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 th rd of health. P G Sigd- . ........ - • -•- -- ----............................................... --------------- --7 Date Application Approved By....._ _� : .. `---•----------------- -•----A -K-n_7 Date Application Disapproved for the following reasons:................... ....................•-•-•----•----••-------••-----...._._.........._......•-•-•-----.................................-•--------------------------•----•------------••-•----------------•-----------_--- Date PermitNo......................................................... Issued....................................................... Date ; No � .N �,•'` Y THE COMMONWEALTH'OF MASSACHUSETTS ` BOARDV,O HEALTH z, Aopltrtttton for Disposal Worki Tunstrurtton ramit Application is hereby'made,for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at Location-Address or Lot No. ........-•-•--------.............................7-----------$-- ----------•----•............... Owner 4z Address a ------------- -------••.-----------.._:_.----•-�• Installer ------•-••---------------.----- Address d Type of Building., Size E s Size Lot.00_�Y/.....Sq. feet U Dwelling —No. of`Bedrooms..... r_......._.._ ..--..--..Expansion Attic ( ) Garbage Grinder ( ).. '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other-fixtures ................................. . Design Flow................. ....................gallons per person per day. Total daily flow............................................� gallons. W ....Septic Tank—Liquid capacity,._ -..-•-gallons Length-- .>__._ Width......-ter_. Diameter................ Depth.-_.......... xDisposal Trench=No............._......Width.................... Total Length.................... Total leaching area.........._........:sq. ft. Seepage Pit No..._.J' ........ Diameter Z5 ..' Depth below inlet .a.. Total leaching area.-545�'s . ft. . h;k Other Distribution box ( f3 Dosing tank Percolation Test Results Performed by:, ' - :"4___._. �° ___. ! ___.___. Date.._ %Z- Ji i _ ._.___... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................--. ( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................ - ......----••------•................... O Description of Soil.......... ..... .. /� � �`��"a� -- ---- -- - - - x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------•----•.---- --•----•--••••------•-------------•--•--•-•-----•..........-•--•-•••--•-•------••--•-•-•-••-•------------•-•----•--•---•.........--••------•------•••--•-••••---- Agreement: 'u a� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL& 5'�f 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...X.. .-•------------•----------------•----------------•-•-••---•--------------. •----•--- ..._........... Date Application Approved By..... _ _ .. Date Application Disapproved for the following reasons: ­'7v ------------------------ -----•-------------------------•-------------•--------•----•------------------------------------------••---.... ................................... .. a Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF EALTH - ., .. ........OF............1........ .:.. ...!. ... .....'.. ...... i �rrtt�trtttr �� tatn�r THIS IS TO C RTIFY, That the Individual Sewage Disposal Sy erl �co tructed ( ) or Repaired ( ) Ji. ............................•----•--....--------------------------•------------ by ... 7,tii�,d "lnstauer -' ------. .... .has been iin accordance wit the provisions of T LE� j of The State Sanitary Code as describ in the application for Disposal Works Construction Permit No... o. ;�r... �4'__..,.____ dated....V -- ----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARAN E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y� DATE................:............................................................... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS + 4' r BOARD GFIi HEAL-HEAL No...t7-. OF..... FEE.......... ......... Disposal irks onstritrtion-Upamit Permission is hereby granted.........=-- ---- - .: ---•-•-------=----•----------...--•---•---•----- ...............--••-• ........ to Construct or-Repair ( a:4 In i dual ever isposal Syst Ael at No...... //g .-- /� T/----- a 1. .... j,•r c r . as shown on the application for Disposal forks Construction Permit Date ............ .. ......... .-. ._ ....... .- _ ......... oar d%f e DATE....... .......... ...................................................... ' FORM 1255 HOBBS & WARREN. INC.. PUBLIS IFRS ' AL a MS! it ` ToP of Fouw0, ,9 t-710 40eoX �-- z 38 34 33.`� SEPTiG x �' �E c H PIT ZS - t------ _..._ _ _. _ - - 3275 • 1it/Eo (V/TH 2 OF ' .- � . • ........— `-'4 � 33.o0 32.00 i �' G T 1 O 1 �,1 Ho -E';�. Sc .4L � 0: i ' i ' (/ T. SGAL � : - o- -o—o---o -- Pr-oposeo% qr-oc.r�cl Psof; 1� 5CHEP 40 P. ✓. 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