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Home My WebLink About1106 BUMPS RIVER ROAD - Health (2) 2wr -)C-, )16,VU -x7*z::Z6 Fim........2. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® ICW HEALTH **' .......V-* **'***-----------OF................................. \\O Appliratinn for Uigpniiaal Vorkfi Corm rnrfilan Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at _ ,o� � � ........................ «c�' Z .....----- Gam'-..._/v .... ._..N....:../ ..U..a 'al t`7ac Y-------------1..�.! -.......1 ....t��. !��.._ �, caner � ress ---.- �Wj .....•.--------•- ............. ............................................................. .� ._ '................. Installer Address Q Type of Building Size Lot_.__.......................Sq. f -t UP DwellingNo. of Bedrooms_.— _.- ----------_-----------------------Expansion Attic ( ) Garbage Grinder ' �a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -•----•-•-----•-••---•--•----- t ® --------------------------------------- W Design Flow....... _______________________gallons per person per day. Total daily flow...............__. ...............gallons. WSeptic Tank—Liquid capacitylZ gallons Length......... Width...._r-�__:_I..... Diameter________________ Depth__,��_________-- x Disposal Trench—No_____________________ Width............7------ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No ______.__ Diameter_:_.(®<_._��____ Depth below inlet... Total leaching area._��_.�:Y._.sq. ft. z Other Distribution box ( - Dosing tank ( ) o `" Percolation Test Results Performed b ,42 rrf J___._�_ ___ � _ Date_/ 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........................ f� -......._•---•-•----•----•--- ----------------- O Description of Soil /--_---------x U ...........�•`�: �._s n ,-- - la'-----./� ............................................ ••--------------------------------•-•----••------- ••--•-------•--•-•-•••---•------....._...--••------•-•••--------- ----••-------------•--------•------•-----•-•-----------•-•-----•-----------•-•- 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 iITAT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been ued t rd of health. Signe .................... = �....._..._ Date Application Approved BY------- -- -•-•••. --•••. ..: ........ .. 2. ........ Date-?• -•- APplication Disapproved for the following reasons----------------------------••--•-----------------------•-----•------------------•--•--•--••--•-•-------•--_••--- -•-•--•------•�--•--------------•--_._...--•-•----•--••---•--•-----•-•-•-••-•--•-•....-•--•-•-••----•-- = Date. PermitNo......................................................... Issued_....................................................... Date .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH ... ..............................OF......,...:..........................----------------.................................... Appl#atioiilor BWpasal ]Vorkg Tontitrurtion lbrmit Application is hereby made for a Permit to Construct k,,-ror Repair an Individual Sewage Disposal System at: 9C ............................................................................. ................................................ Location-Address or Lot No. ............................................................................................... ................................................................................................. Owner Address . ............................................................................... ................. .................................................................................................. Installer Address Type of Building Size Loth---------R-------sq. feRL.;.. of Bedrooms...... U Dwelling—'No. ............Expansion Attic Garbage Grinder Other Type of Building ................ ......... No. of persons............................. Showers Cafeteria Other fixtures .....................I..............:�., ...................0--e............................................................................................... Design Flow....... ........................gallons per'16rsbii per day. Total daily flow............. K/..5t................galtons. 04- Septic Tank—Liquid capacity'�5�t.gallons Len th!��R......... Width... ........ Diameter____________ Depth.J ......... 7.. W� 9 ... Disposal Trench—No. .................... Width.............r....... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No.__Zi,!'--------- Diameter—/ Depth below inlet..a . .. Total leaching areal . p---;s Z Other Distribution box Dosing tank Z a . ... .. .. Percolation Test Results Performed by,4... .q...... .. ............. ......... Date. �a. .......... Test Pit No. I................minutes per inch Depth of, Test Pit................_... Depth to ground wate're----------------------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._._..............__.. ................ f . ............................................................................................... -----------------0 Description of Soil-------/-------------------------------------- ------------------- -------------- --:. ................. -------------- .......... ....... ...................................... --;....................................................................................................................................................................................... U Nature of Repair's or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed.. Individual Sewage Disposal System in accordance with the provisions of TLITT 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. S*-,7 igne .... ...... ..................................................................... ................................ Date Application Approved By..... ......7__ , *- ....... .7f----- 17 Date Application Disapproved for the following reasons:.............................................................................................................. I . .............................................................................................................................................................. -----------...................... Date PermitNo......................................................... IssuedL........................................................ Date -�Af THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH OF................. ................6L:................................................. ..... (9nfiftratr of Toutphaurr THI.,-,-IS TO rERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.............LA4---4-&..................................I.......-7 7--------------------------------------".......... .............................. -------- ......h6 Instal ..A 0��.... a A ........ .Z.p :........ . ___C) has'been inst.Ile with the provision's of of The State Sanitary Co-de as described in the application for Disposal Works Construction Per'.,it No... ...... dated_...(--'--A/------7T------------------ -sta,- TL THE ISSUANCE OF THIS CERTIFICATI.,,, LeO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.,--, DATE...................................................61 \1 ... --------------- Inspector.................................................................................... 1 it COMMONWEALTH OMMONWEALTH OF MASSACHUSETTS BOARD OF OF............m.. ....... ............................................... 45 FEE._...................... o..N ........... 19orka Tonstruction "pamit P io is h .......................................................................... ................. ,ss,O 'erm'ss ----------- to Construct fie,r Repair an Individual Sewage D*s ,4,.d. U V.OS7//�,...SyX4X at No. . ....... ../� 19 9 . ;A�.. n f!......14Z granted..................... treet as shown on the application for Disposal Works Construction Permit �9rj--------- Dated......I.C_ 21........... Board of ea DATE....... 1-2.9............................................. WARREN. INC.. PUBLISHERS _X 7�7 -7 70 4- p 3z 4 oo� 'A -4 o se "O�elz � _/ O _)e -4 4. r- : /`*- z/0 its C T V�e 7, S r—, propt�.s C61 qro ur7d r-OF; e- oll Of 4/91 A.1 77 A Ir 4:5ofS,7' AS�OX s tj 0 was e-.01 Cj rl '44 Z 07 --/ 0 - t e Aq H (7 5 ® 0 ,ol� A)e-Ile AC> 1130,17,9 C�ape /7 1t7eCr_j.4r7l7 -N ,WSW se 7,&- -d< A/ 0 (P 9 r AIS- S..., 74 57 , Ho,_IC r �S,t /-7 7-/rs -�:7, z lrnirL. zo 77.* AP cobsoi ?4 el:t �:Z j ->:5 C-0 AO 0,0*r 4-4L /ACI :,A 7- Ae a r7 -4 -Fin a 7 4>7��Z_ "7 c c/;v rn n V) 3 0 t7O Vj e,-7 c.o u oo r t7 130- 19 45,/ - w r7., �Ciczl *"7 a�e Ir-i 76 Aj 4e) 0 0 a te:�v a.�A/a 4c-A. 7r rl 0"/01*7 IC) AJ _r 6' ',4E? 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