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Home My WebLink About0085 RIVERVIEW LANE - Health p� C�r��e.(L.�-I�l� i LOCATIONtSEWAGE PERMIT NO. VILLAGE I C—e til l 2 ✓v c /lam ` I N S T A LLER'S NAME i ADDRESS 17- • UILDER OR OWNER DATE PERMIT ISSUED DAT E COMPL,,IANCE ISSUED r J(o No........ ............ '> ' .- "� FEE,..3�. .... e THE COMMONWEALTH OF MASSACHUSETTS BOA-RD QF HEALTH :. .. OF ----- Aplifiration for Uispw3al Vurk.5 Toutitrurtion Vamit Application is hereby made for a Permit to Construct ( )-or Repair ( ) an Individual Sewage Disposal System at -•-- -•--- -•-- •---- ---•- ........................ at'o s or Lot No. ..................................... ' i .�lVIf1/�r ------- ......................................................................................... /'� Owner Address Installer Address• d Type of Building Size Lot...........................Sq. feet aDwelling—No. of Bedrooms._.....................................Expansion Attic ( ) Garbage Grinder (/Vo Other—Type of Building ---------------------------- No. of persons_..4;1.................... Showers (A) — Cafeteria ( ) � Other fixtures --=--------------------------------------------------...-----------------------------.....--------------------------------......................... W Design Flow._.... ................................gallons per person per day. Total daily flow......�...3 d...__._............___gallons. WSeptic Tank J Liquid'capacityl gallons Length............:... Width................ Diameter...-___--__-__- Depth................ x Disposal Trench—No. .................... Width_.®............... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No....I............. Diameter-.-___9_--.___..__ Depth below inlet..... Total leaching area..-A f.....sq. ft. Z Other Distribution box ( ) Dosing to 4thof ~' Percolation Test Results Performed b ._. _.,_ 0 ....... Date__-.............:..................... Test Pit No. 1..,,e_A.___minutes per inch eTest Pit...... ............. Depth to ground water---------------------- 44 Test Pit No. 2—:.1........minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of of = 1 '1 u a =. ----irl l - ..---•--••----------- x . ... U Nature of Repairs�or terations—Answer when a plicable.__-----__--. .....•••-•-•-••--....-•--------•---•---••••..... .............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of`'!l 1 7 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n issued by the rd of health. r / �. Si .............. ---•---...................... .............. ........ Date . Application Approved By �� Date Application Disapproved for the following reasons:---•--•-•-------••.............••--•-----•---------•---...-•------------------------•--•-----•----------•------ •---------•--------•--••-•......-•-----•----. -------•-•-- -----•-•-•-•--•...................•--•••--••. p Date Permit No..................... .........--... Issued...ST ... ._...--•--••---•------ ...---------Date-------------•-• -••---••-. THE COMMONWEALTH OF,MASSACHUSETTS BOARD J 0 HEALTH I. ........ ........ ............OF......... , .. ............... ........ THIS I CER IFY, That the Individual Sewage Disposal System constructed (411 ")0or Repaired by............... .... .....................................................h---...er............................... ............................. S1 ------------- - at .... .. has been installed in accordance with the provisions of of The State Sanitary Code as des 'ib d in the 'T application for Disposal Works Construction Permit N ..... ..... dated—.- .... . .................... - - ----0---'y----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ................................. Inspector_..--�_ ` .......Aq.......................................... ..................... THE COMMONWEALTWOF MASSACHUSETTS BOARD 0 HEALTH ........ OF........... ......................... ................. 7�4��-- ... ........... No................... FEE........................ Disposal Forks onstriulion Vrrnfit . ...........................1................................ A ------------ to Constr ct e an '�v I Sewage Disposal Al-7j--7,1 Permission is hereby granted.......... -in i iVd S ...........: ................A..... ...... C/ at No......y -ej; ...... Y,-- ------ ---Sys ... Street No.. :__ : Dated...__ as shown on the application for Disposal Works Construction P" N ------ ated..... .. ....................... ......................... ......... .. -OadHealth DATE----------- -•---- .............. FORM 1255 HOB13S N WARREN, INC., PUBLISHERS t S THE COMMONWEALTH OF MASSACHUSETTS . .BOAR-D OF HEALTH ( ::.. . .-....0 F ....... - Avotirtation for Di4v.13 al Worse Tow1rurtion Vamit Application is-,hereby made for a Permit to Construct ( ) or Repair ( ),,,,an Individual Sewage Disposal System at a o s .or Lot No. f Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----3_________________________________Expansion Attic ( ) Garbage Grinder A46 Other—Type T e of Building No. of ersons___ a YP g -•-------------------•------ persons-..A Showers Cafeteria ( ) Q' Other fixtures .........................._............................... W Design Flow_ _._ _ __________________________gallons per person per day. Total daily flow_-__. ......................gallons. W Septic Tank . iquid capacityl `dgallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width_ ............ Total Length ... Total leaching area....................sq. ft. Seepage Pit No..../------------- Diameter...... Depth below inl ........... Total leaching area_.";4_1-----sq. ft. Z Other Distribution box ( ) Dosin t k ( ) �}� Percolation Test Results Performed by-_ a f- '._______ Date-:''.................................... Test Pit No. l..�Y___minutes per inch epth of Test Pit____ p ground ,.� _ _____________ Depth to water....................... G Test Pit No. 2....../........minutes per inch Depth of Test Pit____________________ Depth to ground water...................... O Description ofloi, ..-.---•--•-•-•• .__W - •.••••----------------•-- -----•---------- f U P f'-- - 7" er'when a plicable.............................................. Nature of Re airs o� A aerations.: -•-- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T`:-.;" y g g p y 5 of the State Sanitar Code— The undersigned furs era agrees not to lace the system in' operation until a Certificate of Compliance has issued by the oard of health. S .ne Date Application Approved By---- r +'i� 0 `- ................... ___ A_____ ' Date Application Disapproved for the following reasons: ..............•--•---•-•-•-•------------------------------------------------------------------------•-•----------------------------- .•-------------------------------------------------------:..._..__ Date Permit No......................................................... 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