HomeMy WebLinkAbout0551 LUMBERT MILL ROAD - Health (2) SI Lu,mbel� (n ll ! E�- Rd
Fizz.....s.�--.°-....................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 'OF HEALTH
'p Applira#iun for Uispoii al Works Tunitrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
9 System at:
.....•.........................................
Location Address or Lot No.
......................... ............................................. -
Owner Address
PXCA.&A.&1K.. ----- -----------------------------------•-•--- ..............................................
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling-VNo. of Bedrooms...........3................... .....Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
W Other fixtures ---------_--- -------- ------ . -
W Design Flow...6.9t...4.,Pb................gallons per person per day. Total daily flow..........33®.......................gallons.
WSeptic Tank—Liquid capacityj.Q.t�_�gallons Length................ Width................ Diameter_______..____._. Depth................
x Disposal Trench!/No. .................... Width- .............
Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....l:.._____________ Diameter...... Depth below inlet..... -......... Total leaching area_ .....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.......1-2-..._._, Depth to ground water.......1�_.�.._..
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_.................
a •-•-----•-••---••-----•-•-----•-------------------- ---....---••.---•••--
O p �':.� ��� r j r - -------- -------�--6-�----
Descri Description of Soil------------------ --- f' L�' - r ! r�aJ -� ..._..
x .....................--•---------••----••--•-•----•--•-------•-•-----•-•---•----•-•-------•--••--•-------------•-••--•--•••--•-••••-------•---•-••--------•-•-•------•--•--.....-••--------------------
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 U 5 of the State Sanitary Code— The undersigned further agr s not to place the system in
operation until a Certificate of Co pliance has be is ed the boa f health.
j" Signed ---- . -� --------- ................................
ate
p ication' pp ved By---------------- .. . -- ...... - --- . _.................. --- - --- - �
Date
Application Disapproved for the f o ,wing reasons----------------------------------------------------------------------------------------••-•-••-------------••---
..............................•-----------------.....•-••---------------------•----------......-----------------------------•-••-----•••-----•-----•-•-•-•--•---•••••••---•-••--•------•-•---------•.-•-
Date
Permit No.------ ....................... Issued............
--------�- L
Date
No. FRz S 0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. ....---------...OF................................_......
Appfiration for Disposal Works Qlaustrurtion jhrr4it
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
---------------------------------------------------------------------------------------------
Location-Address or Lot No.
.....611 ` V............................ .................................................................................................
Address
zz' . .......... ...................................
.......... .....PX!�_AeA 0
Installer Address
U Type of Building Size Lot............................Sq. feet
�V
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons.........._..........._.____ Showers Cafeteria
Oher fixtur s ......................................................................................................................................................
Design Flow.._( �f.p...........gallons per person per day. Total daily flow............33-Q....................gallons.
o
9 Septic Tank—Liquid capacity.1�2......0
.gallons Length................ Width....._.._......_ Diameter-_._-___-__._-.. Depth............._..
Disposal Trench—No..................... Width..... Total Length.._....._ ... Total leaching area ...sq. ft.
Seepage Pit No.J----------------- Diameter.....L.......... Depth below inlet......_.....____. Total leaching area._._ sq. f t.
Z Other Distribution box Dosing tank
�_4 Percolation Test Results Performed by........ ...... ... Date..............____._...
0.4 --------------*-----------------------------V-- - .. ff)�------
Test Pit No. 1----4n-2—minutes per inch Depth of Test Pit.......[L....... Depth to ground water--___-_I I................
44 Test Pit No. 2................minutes per inch Depth of Test Pit__.._..._......._... Depth to ground water.._......_...__.._......
CA ............................................ .....lb..........................i�_Iff............ . ... ... .......rt......
0 Description of Soil.............2'.J........
............ ...........
.... .............i..........k. ............6_ ..................C.. . .....................Z-2:......
w 5-�_L �C_._ xl f......�P..JV2...............................................................................................................................................
..................................... .................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...............................................................................................................7.........................................................................................
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 .,-ees not to place the system in
operation until a Certificate of CC pliance has b9en ispded y t boa yd of health
igned .......
.............................
Dat
icationpr ed By........ ............ ............ ............................................. ........................................
th
Date
a
Application Disapproved for e ollowj g reasons:................................................................................................................
......................................................................................................................................................................................................
Date
Permit No.__2_7.......2.L q....................... Issued.......................................ems................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. ....................OF.....................................................................................
Trrtffiratp of TI-Intphaurr
TV 4S P) CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
--'--by........ .. ..................................................(I.................................................................................................................................
VaInstaller t._t27...5.Z......... .13 7 5......�'. /-7 PC b Z�,/-/0
.................................................................................. ....................................
has been ifstalled in accordance with the provisions of TITLE 5 of Tl)& State Sanitary Co4e-as clescrtt' in the
application for Disposal Works Construction Permit No......5?S .......... dated................a...... ......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIM)rS� , ACTORY.
DATE..................
...........E�/... ................................... Inspector---.... .......................................................................
L-ie 7 7_iCKTHE 'COMMONWEALTH OF MASSACHUSETTS v.1—i if
tv 90r. BOARD OF HEALTH T3 f C C-7 W
.......................OF.............._ e
.... ......
N FEE........................
'° r ;
Permission ereby grante
to Construct im!�h
,[t �...-5_Z---_--•.or�Repair an Individual Sewage Disposal.System
... .......... ...... . ..
fat No..........0 ..Z..U.P"_ ....... ............... . ............ ..................
Street 9
-_ 5;
as shown on the application for Disposal Works Construction Permit No....... D ted.......2-1
11 6 ..............
- - ---------
................................ ....kB j 7'd'of ----*.................... --------
DATE........ "4�.. ...*
FORM 1255 A. M. SULKIN, INC., BOSTON
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