HomeMy WebLinkAbout0068 BUMPS RIVER ROAD - Health 00 - � 3�
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LOCATION.. SEWAGE PERMITNO.
VILLAGE
fA"A - A .- lzo
I N S T A LLER'S INAME 6 ADDRESS
r .Cori-/ ""rip '
e U I; DER OR OWNER
DATE PERMIT iISSUED
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DATE COMPLIANCE ISSUED
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THE'COMMONWEALTH OF MASSACHUSETTS
BOARD HEA T
I/— I
I . ppliratiun for Rapnoal Morks Tonstrnrtion Prrutit
Application is hereby made for a Permit to
Construct ( or Repair ( ) an Individual Sewage Disposal
System at:D W1 j
__-- .---..Y... ......
-
L i Ad N- ---------��/Xdd,esO
-9-----4R4..
I taller Address (�
U Type of Building_ Size Lot..a. i__� T.Sq. feet 1
�-, Dwelling No. of Bedrooms-------_____________________________________Expansion Attic (� Garbage Grinder
`L4 Other—Type of Building ............. No. of ersons........._._._..._.......... Showers
a g ----•----••-•-- P' ( ) — Cafeteria ( )
Q' Other fixtures --------------- ---------------•--------------------...------------------...-----------------------------------------...--•--------•----- ------
WDesign Flow.......:.._.: vr�.................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity-6 gallons Length................ Width---------------- Diameter---------------- Depth--._-__-•-------
x Disposal Trench—No. .................... Width__-f .___/-......
Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..........I........... Diameter_._ Depth below inlet............... Total leaching area---3J-7r_sq. ft.
Z Other Distribution box ( ) Dosingtank
Percolation Test Results Performed by.._,�Zj(_A�--------
A.__ e 9-S__--plg,--------- Date... 3A---4-1-_--_------.
,4 Test Pit No. 1__,C2_..._minutes per inch' Depth of Test Pit.................... Depth to ground water--___-_____--____--.----
fX4 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
P4 -------------------------------------- . + -----y--- -- f------- ..-
O Description of Soil-------nt � Z 1Q1! �1 8�sr�
x 2
U ---
•--------------------------------------------------------------
•---•------------------------------------------------------------•------------•-------------------------------------------------------
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ued b �har o dealt .Si - -- -----------•--- • -•--•------- . Date
Application Approved BY - mil_ch
----------------------- �' .� ��--------------- --------- ----------
ate
Application Disapproved for the following reasons----------------------------------------------------------------•-----------------------------------------------
Date
Permit No......................................................... Issued._"" � -'S-•-••----------•---
Date
..
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
Appliratiott for Mavooal Works Tomtrurtion ramit
Application is her,,eby made for a Permit to Construct (4 ) or Repair ( ) an Individual Sewage Disposal
System at: '0 � A
u. ----------- ............................................... •---•-•-- -••--•-- -----••-•-••-•-••----........•-•--•-•----------------- ..--
j Location-Address ror Lot No.
(/ / Owner - �• �, l l Address✓j
-•---•—`----------------------------- !!
Installer Address •^�
d Type of Buildin ., Size Lot--O" ''_ �'"�Sq. feet 1
Dwelling Nn. of Bedrooms_______.................................. _Expansion-Attic (�-') .i Garbage Grinder`4 Other—T e' of Building No. of ersons________________
W YP � g ---------------•-------•---- P • ------•--- Showers ( ) — Cafeteria ( ). • .;'
a' Other fixtures ......................................................
n- Design Flow____________�r� __ gallons per person per day. Total daily flow............................................gallons.
W'-•
W `, Septic Tank—Liquid capacity? w.gallons Length................ Width.......--------- Diameter________________ Depth--------------
Disposal Trench—No_____________________ W idth___ ........... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No ___.__I.........._ Diameter_..' ___ Depth below inlet____ __.___- Total leaching area__31Y_7.__sq. ft.
Z Other Distribution box (. ) Dosing_ta ( ) -� ,✓^ • -~ p �. " /
'-' Percolation �`est Results' Performed by..,: w-_.-_.__,fa__: t _ __._ ,.......... Date__
Test Pit No. 1_„ ______minutes per inch Depth of Test,.it------------_....... Depth to ground water-__.----_____________--
Test Pit No. 2!____..........minutes.per inch Depth of Test Pit.................... Depth to ground water_._...._.__._________---
tx i ,
O Description of Soil_ .-" - ��^ ` f .------_------------------------------------
x
U ----------------------------------------•---------••-••-•-••-•--•--•••---- = =
W --------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________
-----------•------------------------------------------=----------------------------•-•-----._...----------------------------------------------------=----------------...--•--.._..-------------------
Agreement: 4.
The undersigned agrees to instal the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
Si dt L ��--i7 . __
Date
Application Approved BY----- ✓ L � -----_-------------- -
Date
Application Disapproved for the following reasons:.................................................................................................................
.F
Date
A Permit No..............--••-••-•-•=- ----•.............•---•---- Issued.............................. ...................
_ Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... t .: ,/r�...........OF..........14� 4'S+'.L. ................................................
Tutiliratr of Toutpliattrr
THI4 IS T•0 CERTIFY, That the Individual Sewage Disposal System constructed ( ') or Repaired ( )
by ---- •---- --
✓ Installer
w / ... _•••--�.:-- ----------
has been installed in accordance with the provisions of Ar c�le 1�I of "fhe State Sanitary Code as descri ed in the
application for,Disposal Works Construction Permit No.-_7 ___ _ dated.......,!.t ...*_.._ ;1_____________
THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE__ .. "'`.. -"-- �
/' .........----- -----•---_--. Inspector_ ____
.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
..../ ...........OF.......... .......................
No. P,,�,,`",_ FEE. �
............ -------
Permission is hereby granted___'_ a__.... _. ar__
----- ----- ...................
to construct ( on Re, ai ( an Tn,.. a ewage Disp s System
' ,
r
t Stree4� F
PP P ion rmit N k__.as shown on the application for Disposal Works Construct Dat
�
- .---- --------------•----
Board of Health
DATE... " -47 t --
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
3 +501.,-44S6.RR --
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SQ.'nC. TA-sw. • 330xZo0
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1'ISPOSAL PIT Ugh 1coo,!��l'S STAdp
51 C>ejAIAL L AZZ A s
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t-iEQE.ow C.omPi-Y S worm TµE. rptrw- "cm
AND SMrSACK iZeD�1�.MFsuT+; Ot= TyC� 33
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T"K, 'PL&W IS UOT BASED ON Au ILKTWMEuT AAA,c
5u[v�t T"ra OFFS T; a$"WLto' uoT 1415 use
To 'Ve.Tr-ZmiNE %.oT uusg. APPL/GAw-r �2G� l�,a�A I n�Ty Irzvsr
No.......Jil-.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--------- .........0F.........r ...............
Application for Btspaual Works Tonstr rtion Prrutit
;�f,45�0 Application is hereby made for a Permit to Construct (V or Repair ( ) an Individual Sewa,a Disposal
System at:
..... -! :?...... :! ........................................ ......................
l 6.. to .. ' ....--•---••--•....---------•-
Location-Address � .. of No.
a,.a.�l --•-- - .A ,./r.,le_f ed .......................
.... — o
GOwner tess,
W0, a.�.._.. ..� -�. .m ....................................... ...../�l_.__ ,!a t.._.. ...... ........._.................................
W �_._.. ..... q
� � Installer Address"
Type of Building Size Lot....2.A......_.....S feet
Dwelling—No. of Bedrooms ................................Expansion Attic ( ) Garbage Grinder
Other—Type of Building ..���......... No. of persons.......... ......... Showers O — Cafeteria ( )
Otherfixtures .---' _..r'�. .-----------------------•----------- -------•----......--------••--------•--•----••---------••--•--•--•-------------•--------
W Design Flow.....................--J.............._g lions per person per day. Total daily flow...................._.__.._...----...__-__--..gallons.
W Septic Tank a-Liquid capacity./dons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width_._.......��,,--��-,��To al Len h.... ......_._..._. Total leaching area....................sq. ft.
Seepage Pit No....... Diameter/��--•---`'D"eptl e`fo� ............... Total leaching area..................sq. ft.
Z Other Distribution box ( } Dosing tank ( ) �'�- /�C l.- 2-/X 7/7 y.
'-, Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........-_-.............
R'+ / ... �.f------------------ -1---------------I.....- --- ..........-•----------•----...
Description of Soil------ •Ss'L{ + ij�j'// `9 �� � 2c - -G?err`"
U ---------------------------------------------------------•----------...........-----1� ...-................................................................
-----------------•---------------•--------------------------...------.
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 Article XI 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.
Signe - ----- ------------------------------ ------------Da Da.-te..............
Application Approved By.....jiv . --•- -- ------------- 7--�---.-----
Date
Application Disapproved for the following reasons:....................--..........................................................................................
•..............•-•-•-----•-•----•--•---------••-•---------------------------------------•---•--------------------------------•-....------------•------------------------------------••-...........-•--
Date
PermitNo....................................................... Issued........................................................
Date
No........ke Fps. ... ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
OF..- +'' ................
AvOirFation for fkiivoii ai Works Titus strurtion ramit
Application is hereby made for a Permit to C09Wuct ( o epair ( an Individual Sewage Disposal
System at: // 4
4 Awv:..................---......--•.......... ......:...............
--
ocation-Address "' ., of No
.:. ...�. ..................•........ ....G�CI . .........................................................wner c A re
a .. --------•-• ---- ' . . ....-- ............................................
I aller Address*
Type :0:f�
tiding Size Lot....5.9......_..._.Sq. feet
U Dwelling No. of Bedrooms....::.:.....4.........................g— Expansion Attic ( ) Garbage Grinder (A-J"''
Other T e of Building
a yp b �^( _.___.._. No. of persons.......:_'_'_......... Showers (�) — Cafeteria ( )
Otherfixtures . .,� ...........................................................................
-----
W Design Flow................. *.6. _.__._ llons per person per day. Total daily flow............++�0'"ll/................gallons.
W Septic Tank 2-'Liquid capacity_/P__'j4lllons Length_._,_ .....____ Width................ Diameter................
�., Depth................
Disposal Trench No. Width._. _. Total Le h,, Total leaching area....................sq. ft.
Seepage'Pit No......�__..._.. Diameter/0-rJ__ oe t)Rfet�e#t_.............. Total leaching area..................sq. ft.
Z Other Distribution box ( . ,).� Dosing tank ( y.
a Percolation Test-Results Performed,-bY Date........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................
114 Test Pit No. 2..........•.....minutes per inch 'Depth of Test Pit.................... Depth to ground water........................
' 4 . i Description of Soil.......
U .......................... ............................... .........................
UW ------------------------------------------------------- --•--•--•----•••---•---•----••• •.• .......................................................... .............................
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health. .
Sign e �.._,`
ate
Application Approved By...... .• • •••. . . •---........ ;�" ate
Application Disapproved for the following reasons: .......................................................................................
.............-.......-------•------•------- ---------------------------•----------------------•--• ,
Date
PermitNo..........................................::........:::.. Issued.....--...............................................
Date
THE COMMONWEALTH OF MASSXCHUSETTS
BOARD OF HEALTH
......
Tntif iraatr of Tompl Faatrr
THIS IS TO CERTI , That the Individual Sewage Disposal System constructed ( �Oor Repaired ( )
by....... /`—� ------•----- •-••-----•- •-•-------•--- ....... .............
Y I staller ^
///
has been installed in a cord* a with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated...... _�_ �._�._.--_------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU9 I) AS GUARANTEE THAT THE
SYSTEM WILL FU CT ON SATISFACTORY.. .
DATEi .. f..........f.................... .................. Inspector....... !-'�� ,?:.p:... ................................ -"
' THE•COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ..;,
.........OF:.......... A..........
No......................... :. . FEE........................ .
!� 7y
air rtrratCerait
, ,
Permission is hereby granted.''" .... �`' 'h�. .............. •- - ................... t .
to Co uct ( ) or Re (' ) an Iage isposar stemat No.. r
Street
as shown on the application.for Disposal Works Construction, Pe No. Dated....: ; ' _ref..--•--------
o eat Boar -
D. ._ .....f ..�.. . ...Ssz•.. f.. " r.....
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
o
i
�. 4 ,
. Y �
No .........! � Fxs.. . -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,�FHEA T
.............. ... .. ---...--......OF.. ---•---. ......................
ApplirFa#iou for Uhipoii al Works Tonstrurtiou rumit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Systemat: - -••--_. � � !'�--- �'! •-••. ---•-- ........................................................
.......... .. .. ...... ._--, .....
j oca dress or Lot No.
//r�� j
Owner AddAs
La6.
,•a
Installer Address
PQ
UType of Building Size Lot..... Sq. feet
,., Dwelling—No. of Bedrooms___________________________ ______________Expansion Attic ( ) Garbage Grinder
Other—Type of BuildingNo. of persons____________________________ Showers — Cafeteria
a Other fixtures -----••-•--••------------•------ . -
d ----------------------•---------•----_-___...............--••----••-
W Design Flow............................................gallons per person per day. Total daily flow__.__.__________...._..______.____.___._____gallons.
WSeptic Tank—Liquid*capacity.............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.___/ArV.... 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.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---:....................
Pa' --------•-----=--------------------•-------------------•---•---.....----......................--•---................__-----------------•--------•--_---
0 Description of Soil........................................................................................................................................................................
W -------------••-• -------- -----------------•---------------•-•------------------•----•--------•--- ------------•--- �9 rG f �i
UNature of Repairs r A erations—Answer when a li ble.-•--..- ..--- ...................................._ .
�.
--- .�' .
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIM2 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue t oa ea `
Sined :............. ..:..........•-- --•••-•-•-•------------•---_--••. • f----- e
�.
Application Approved BY---------------------------------- ........... ------- --• --•---• ............... •---�� l -Dat
•--- -------•=--
Application Disapproved for the f oilowing reasons- ---- - ----------- •_- ___-__._.._.._________-__........._
..................•-----•.••-•---..__.._......__....---..._.....----...-`•----•--.............---••---•'--------...._..--•---------- --------.....-----••----•---------•--•--....Date ...........-
--z5 -7
PermitNo......................................................... Issued............... � -----
No.--�.........�'�� , F�s..�...
,1._�..J._...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® ,OF HEALTH
Appliration for Uispoottl Vorkg Tonstrurtion ramit
Application is hereby made for a Permit to Construct ('"") or Repair ( ) an Individual Sewage Disposal
System at . ----------
w 1
---•---------•.......................
LocatA Address�ra ' s f/� J or Lot No
r Owner ,� Address
Wi * Le. "S , _ ........_ •t c ....... .. ... . ...... ....` �
..
Installer Address r
Type of Building I Size Lot--:2 ...:"`_........Sq. feet
Dwelling—No. of Bedrooms...................... ..................Expansion Attic ( ) Garbage Grinder ('
aOther—Type of Building ........................L. No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures -----•--•---------------•------• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.____-- ... Diameter.................... Depth below inlet.................... Total leaching area.........._.......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aa Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ............••---•---•--••-----------•------------------------------------------------••----•-------.........................................................
0 Description of Soil......................................................-•--•-••-•---•--.....---------------------------•----•--.....-------------------------•-•-•.....---------•----••-
x _W ---•-•----.--• ••-----•----------•--------••----••----------••--•-----------•-••..............•-••---•-•-•.-•-- . ...--�._6....... _ -------•-�.....-- ...__ .....
x eel � eat ' �; J Rr
U Nature of Repairs or Alterations—Answer when applicable.--____._s ____._.__ _.. ......... .��.. .�... .........
. ', ; '. ..... ra ----•-••---------------------•-•......
._._.....................
.........
.......
---......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued4by the board of health.''"
Si• _____ r
mod__ .........................•--•....---
A Application Approved B f` ' r
PP PP y---•.............•------..._...-•-...•---•------ --......... . ......------•-_---_.. --••--. ---- .......
.................................. Date
Application Disapproved for the following reasons:. .... ............ ....... ............... . ........._.__
--•-•----......-•..................•-•---•-•-•--•---•--.......----•------.................-•-------.......--------•---............... --•-------------------------------- .......
—1� 7 . "' T�_ 6 / /....lG a.Permit No......................................................... Issued...................... -
Date
_ �__._. THF�COMMONWEALTH OF MASSACHUSETTS
- BOARD OF; E TH
....�....�..................OF................ ��.....................................
Tntifiratr of Tontpliona
THIS IS That the,3ndividual Sewage Disposal System constructed ( ) or Repairedby---------------------4!!:MFY,
(.. ...�: J............................................... _--------...---------------- ------
.................-.......-------
.
Ins 1
atp—rr?.. --•---------.._ .....................................................•....................
has
application on foreen 11ed in DisposalcWorkseCons1 the provisions of TI7 5�# ��State Sanitary Co
�lf �lesc� �n the
Construction.Permit No dated --- ------ ---•...--------
THE ISSUANCE OF`THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................................•---•-........_........ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
...........................................OF........ ................................................... S ,
No..... ............K--C� FEE........................
1iopoo orko Tonotrurtiort rrntit
Permission is hereby granted.---.•••.-�✓•-•r-•-1---------- ..---• •---------------------------•----------•--............------.............-•----.........
to Construct or a air an raid e� a e Di SS S
atNo...................� .. --------•----•-•----• .4........_.........------...................__ ....----------�----------•---•----------•- ---------.-...........:..
Street 'J 7 / ^
as shown on the application for Disposal Works Construction Permit _
PP P � /1 ._
................................................ ---- ..............................
Board of Health
DATE------------------------------------- ----------------------------------•----
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
vn 4 l`.%f cL=ft►a 9. t to 4 3 +5oly 4%f.-P.M ::�'�•-•.,.F phi __.. .,.
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