HomeMy WebLinkAbout0882 BUMPS RIVER ROAD - Health o 5����
No.... ..... �-�... Fms..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
Appliratioo -for Miivviitt1 lVarkii Tutwtrortioit Vrrn it
Application is hereby made for a Permit to Construct ( or Repair ( an Individual Sewage Disposal
System at: e
.....---.--
ocation-A dress or Lot No.
..........•......h.. ....L,c.... ..... .. ...•••............•.................. ------•-•--•--••--------...............................
wne Address
w ...
Installer Address
QType of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of BedroomsN.,-3..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons_..-______-_______-_--_.__ Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- --
d ---------•---•------------------------------•------•----
W Design Flow--------------------------------------------gallons per person per day. Total daily flow..----_____-__-_-__-__._-__________---_____.gallons.
USeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter_____..._..-___- Depth.-.._.___-_---
xDisposal 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 ( )
aPercolation Test Results Performed by--------- ---------------------------------------------------------------- Date--------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of :Pest Pit.................... Depth to ground water.._.________..-._-._----
44 Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water-_.__._..__.___.____..__
►x ---------------------------------------------- .....................................................-•..................................................
0 Description of Soil------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------
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 Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has een ' su by the, pa f ealth.
/Signe .... � / 1+
Application Approved By---...• =1�------------------------------------------------------------------------- --- -------;-, 7
Date
Application Disapproved for ie following reasons:...............................................................'---------------------------- a• ..............
--•---------•-----••---•----------•-•---------------••----•-•-----•-•-------••---•-••....---•----•---••••..•--------•--------------•-• -------------•----•-•-----•--------•......••--•-_.....---•--••--•-
Date
Permit No....... Issued............& --A-n-Z--3-••----•--•----
Date
No.- -•�1............... ..............................
THE COMMONWEALTH OF MASSACHUSETTS
EOARD F HEALTH
.� -.......OF .....L ....
;3. Appliration -fear Uiiipuittl Works Tomitrurtion Urrmit
Application is hereby made for a Permit to Construct ( or Repair ( . an Individual Sewage Disposal
System at: e
............. AV` ---------------------------------------------
ocat on-Addres or Lot No.
------••-•------ ••---• ---- - ... •---- --- ..................................... -.----------------------------•---------••-----------.....-----•-----•-------------•--...--------
ne Address
w �� G�s.�.���5
-*T:Installer . , Address
d Type of Building ` -._ - Size Lot.....-----------------------Sq. feet
U
Dwelling—No. of Bedrooms--__. ________________________________E:Ypansion Attic %Qarbage Grinder ( )
p-I Other—Type of Building ----------__________________.No. of persons--__________________________ Showers ( `)'— Cafeteria ( )
a' Other fixtures _____ _____ '
w Design Flow............................................ per .person per day.3 Total daily flow...... _.__._.__ ._. gallons.
9 Septic '1< }ks—sLiqu�d�cap�&it`t� ga116,*�v Length________________ Width...._......... _ Diameter__.__.-._---___ Depth '^----------
Disposal tienchfi'=No. '.'. ........... __. Width__ a_______ TotalyLength___________________ Total leaching area__ _. _____sq. ft.
Seepage Pit No____________________ Diameter Depth below-- let _________.______. Total leaching-area-____- ----------sq. ft.
Other Distribution box ''Dosin tank ,"„��•� �d
Percolation Test Results Performed by Date.
--- --------- -------------- --
a Test Pit No. 1................minutes per inch Depth of i est Prt `__- Depth to ground`W iter -__ _._.__-__.. .
s,
f� Test Pit No. Z................minutes per inch Depth,,of fest',Pit-------------- :. Depth to'ground water. _-_--____--____- -.
------------ -- -- ---
O Description of Soil ------ ----------------- -- -
x ,
------------------------------------- -------- ------------------------------------.............................
0 Nature of Repairs or Alterations—Answer when applicable ._ '" e_. --------
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 een ' su by tth ealth.
Signe -- ----- --- --•• - `�r-------- f!?
y ate
ApplicationApproved By--------------------------------------------------------------------------------------------------
Application Disapproved for the f olloiuing reasons:........................
--------------------------------------------------------•------------------.._-----••--------------------••--•-•• =---.:n:.--*-'..---_... -------------
D"a'te
Permit No....... Zz. Issued. /
--- ,a
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f (111rrtifiratr of Tontliliaurr `
d' S
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ("`v or Pepaired ( )
Q s=
by............... 7: 5 Sly -
I aller 1*��
at ................ .u. Yd° ----- �fU O---------------i ,---- >--�1�.7`Ck ---�c„
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
y application for Disposal WrJc construction Pe'rmit�Into _ �' ""t
- ----- dated------- .........
THE ISSUANCE OF'T1IIS CERTIFICATE SFIALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTIO7N SATISFACTORY.
DATE•- -- tZ. Z ?_:_ Inspector �C✓-�'e='".•�
THE COMMONWE/t1L�H OF MASSACHUSETTS r,
BOARD FOyF�'°'HEALTH t `:
D ! `..OF........ia� ^. 5 'G ...............•�79' k a y,k° _, r, ` w:? FEE_ :`....... ,
Permission is hereby granted_________ __ __ ____CS, d_AG,�r------------------------------------------------------ _
to Construct ( �) or Repair) an Individual Sewage Disposal Syste
at No...... ._
as shown on the application for Disp6sa Works Constfatontleimit No....J� "__ Dated......&__,i -._ ............
Y� a
�'- !SBoar Healt��//
DATE_ �_��
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FORM 12 5 HOBBS & WARREN. INC PUBLISH S
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