HomeMy WebLinkAbout0075 BUMPUS ROAD - Health 75 Bumpus Road -,
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LOCATION f/06Z ZbO/OW A614D SEWAGE # ��'F— W7
VILLAGE ASSESSOR'S MAP Cz LOTS/0
INSTALLER'S NAME & PHONE NO.,,e0trTaLor-1 e!0Ars7Z /,U<2° 771-V33;37
s§EPTIC TANK CAPACITY
c3.EACHING FACILITY:(type) �,17— (size)-6,K6
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER 1404441
DATE PERMIT ISSUED: Ile
DATE COMPLIANCE ISSUED•
VARIANCE GRANTED: Yes
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VILLAGE /')ice ASSESSOR,'S MAP&PARCEL
INSTALLERS N E&PHONE NO.
SEPTIC TANK'CAPACITY
LEACHING FACILITY: (type) (size) .�
NO.OF BEDROOMS
OWNER 't
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table,to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Ede of Wetland and Leaching
g g Facility(If any wetlands exist
within 300 feet of leachin facility) n �, Feet
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.......... ...(..0t .!)...........OF.....� � hD ` 8-Lam_.._.:......................
Allp iratiun for Uhipuiiai Workii Tunutrnr#iun ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
•---.......`� �..g,1.14!l.P.. .--.Q0 A.b . `�11'�1 .....•------------------ "'�- 4 l L-
Location-Addre or Lot No.
........ T�� ...y�. c��' �A--c , ............. y .o:u t�'i�:.................--
-- -- -------- - -....-. --
Owner Address
W
a ...........
Installer Addreddress ...............................
dType of Building Size Lot....... e.. ...Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building .... No. of persons............................ Showers — Cafeteria
Q' Other fixtures ------------------- -------------------------------------••-••--•-----••--------------------•----•-•--•--•-•••------•••••..................------
d
W Design Flow............................ss......gallons per person epr day. Total daily flgw--- - - •...._gallons. V
C4 Septic Tank—Liquid capacityl®®_..gallons Length.__....-4ca_.. Width4.—A�._ Diameter-............... Depth.... _....__
W Disposal Trench—No................ Width ........______. Total Length......._._ Total leaching area....................sq. ft.
Seepage Pit No........___. ---__... Diameter..>l�.r-®.e . Depth below inlet...p: t�. Total leaching
Z Other Distribution box (Irk ' Dosing tank ( > �•
'-' Percolation Test Results Performed by.... ..____ _C.. �k'+�.... _.�r1. 4✓l Date........... ..l 1
Test Pit No. 1.......�:n....minutes per inch De th of Test Pit---- fit. Depth to ground water.......
!4 .
fro Test Pit No. 2........1.minutes per inch Depth of Test pit....1.1�1...... Depth to ground water.......K44L(!e.
. > 1+
Description of Soil-...O. a..l_. .......Tp.5.4_/__ _j� .._.-_. _--- �j`✓ y_ --_-- -- Z
---------------------------•--------•------------....---------•----•-----------....----....--------------------------•----•----.....----------------------------•----------------------------...........
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 iITI U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be iss ed by b of health.
Signed. --•--• ---••-•••... J ... . 4' -=- ------------------- - ... .. .6
Date
Application Approved B .... - ............
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------------••-•--.. ..........._
...................-..................................................................................................................................................................................
Date--•----
Permit No........� g 7...................... Issued_................___ ------•----
' ' ...-•--•----- -•--- Date ^------•----
No.--36....-It 1. Fas.... ..`a.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ..r ........', ------.....OF...... 1 �?. .... � .��
Applirattion for Disposal Works Tontrurtion rrmit
Application is hereby made for a Permit to Construct O• or Repair ( ) an Individual Sewage Disposal
System at: _
................------•---...... . -=�--..............----................... ---....------•----...---•---------•--•----- . '..........................................
.. ' Location-Address y� or Lot No ...t.. ....:.................
...................... ... ..... ........ ••• ......•--•-•... --•'-• ....
Owner Address '
W ................................................. .............•••• .........•--••-•............._-
Installer Address
d Type of Building Size Lot..._3 ._.. ._._Sq. feet
Dwelling—No. of Bedrooms...........:c...............................Expansion Attic ( ) Garbage Grinder ( )
4 Other—Type T e of Building ___.... No, of persons............................ Showers — Cafeteria
Pa YP g P ( ) ( )
P4 Other fixtures ----------------------------
.. ,. _Z
W Design Flow............................ ------gallons per person per day. Total daily flow........................`'... ��......gallons. t�
WSeptic Tank—Liquid capacity`a(!:?...gallons Length..'�-t.__.46{.. Widthl..:~� .. Diameter. -........ Depth..-: _.
x Disposal Trench—No..................... Width....._._..,.._._.... Total Length............!...... Total leaching area...........---_..sq. ft./
Seepage Pit No_____________________ Diameter-� <�_..._. Depth below inlet._. :.:_�..... Total leaching area.. ...ggIt.6 P4P
Other Distribution box O4) Dosing tank ( ) f
`-' Percolation Test Results Performed by...............................F � `3 ` u �''t.... +'?..... Date.._..._. . .� Q
Test Pit No. 1.......^".....minutes per inch Depth of Test Pit _I`11- __.. Depth to ground water------
Test Pit No. 2........ ..minutes per inch Depth of Test Pit...!Af: ..... Depth to ground water___-_
O Description of Soil... r� s r ... z f1,d .. .: r..a, .e��.... �4
�+ f1 ! {fJ.i? �tl._`'_ At.r.:to, � r�h _ r1 ' ._` _`:. r. / lt^'! !VJ�a s,l .......__...
(� ---
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 T ITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has7beiss edby t b of health.
Signed. l4,7.........1. ... .__. ..
Application Approved By..... .................... = -r�
Date .........._
I
Application Disapproved for the following reasons:....................................................................................................
--••-----••................•-•-----------•--'---....---•--------------...-------------'--•-•-'-----...---•••.......__....•-•-•-•••--••••••-•••............._._......••-'•.•--••••-••-•-•-••••--••---••-•
Date
PermitNo....... - ..................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ......OF...., !?t
. .. ...............................
Tntifiratr of Tomplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
y......................................--•-•--•---••---------•---------------•.-...-.-•---- ---------..-------------------•---•------•--••----------•-- -----...-._-.----.--••--•--•--------------•--
Installer
has been installed in accordance with the provisions of TIT-t 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... _._...(C.J..... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE 9
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................ _ :....1
--••--•---...... Inspector............
•-----------
.�..... ..........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L� 7,
... p It! � •-,� ..........................
pp ..I... ...
No.... .Q.:•-•-........ FEE..... ............
Disposal Works Tontruction IP
rrntit
Permissionis hereby granted........................................................................................................................................--....
to Construct or Re air ( ) an Individual Sew 5 Disposplj System
-
st t ��� 1/
as shown on the application for Disposal Works Construction P r 't No.J%_�_i1.. -�__. ed... _. . _ �................... .c•
DATE.......... ( C,7. ..................•----.......... Board o alth
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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