HomeMy WebLinkAbout0146 RIVERVIEW LANE - Health S M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE
MRMW MIN.RECYCLED
INITIATIVE CONTENT 105;
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TABLE
�I TOWN OF BARNS
LOCATION Lug- Z� L0,ef\&tw ��►^C SEWAGE # 9/_ N L
VILLAGE Cevt ASSESSOR'S MAP & LOT 2).j-)bf 601
INSTALLER'S NAME& PHONE NO. 1st. 04,Scd\l
SEPTIC TANK CAPACITY 1,006 Corti 160
LEACHING FACILITY:(type) (.�K�I.• �� (sue)I—UL*X)ji 0iiS
NO. OF BEDROOMS PRIVATE WELL O BLIC WATER �PU
BUILDER OR OWNER �30`�(A ��� i � tql
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No... ,f:...� ...� FEB
THE COMMONWEALTH OF MASSACHUSETTS
773 8 BOARD OF HEALTH
----._......ZOWjV.....OF......-/
Appliratiun for Dispuiial Works Towitrurtiuu prrmi#
Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal
System at:
zNrNT _v._.lc_La
L ea on A cess r Lot No.
.. _.Y. .�� ....... ... .................................... r�°x---q-s �cr R✓�
--.....---
caner Address
.... --------------•-•------------ ........-•-•--. -•--•--•----......-•--• �.....................................
�
Installer Address
Type of Building Size Lot....
..____r..............Sq. feet
U Dwelling—No. of Bedrooms..........-3................ .Expansion Attic ( ) Garbage Grinder (4/0)
PL4 Other—Type of BuildingU/0.01)._f"AAMC No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------•-•---•-••-•-------------• .
W Design Flow.................5.5................. per person per day. Total daily flow_......33.Q_........................gallons.
WSeptic Tank—Liquid capacity/0,00..gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......... Diameter.......9......... Depth below inlet....4............ Total leaching area! ......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'.-4 Percolation Test Results Performed by ...�!e.?` Y .................................. Date.....`f..... `.1........._..__..
Test Pit No. 1... _-_•minutes per inch Depth of Test Pit......02_...._... Depth to ground water----AT g...
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---•---- ---------------------------------------- ----- ------- ------------------------------•-•----------------------------------------------------
O Description of Soil..... ....Ley f'..............V.8 5 D./L.� _...................................................
V ----------------------------------•-----------•---------•------------------.......--------•-----------•-•••-•----------------------------------------------------------------•-••--••••-•...----••....
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'TTLE
p S of the State Sanitary Code— The undersigned furti:er agrees not to place the system in
operation until a Certificate of Compliance has been i ued by the board of health.
�� .z 2 -1/
Signed..._:... . •--•----------------
Date
Application Approved By............... !!-��*: ••�
J......... 3-a3-
Date
Application Disapproved for the f o owing reasons-----------------------•-----•---------------------------------•-----------------•-------....Da•_.....•--------
..---••-........•--...•••------•-•-•----•-----------•-•••--•----•---•--••--•--••-----------•-•---....--•------•--•--._...-••-----•••----•••••----••-•-•----------------•-••-•••-----•......---•...•-----
C�J �7 Date
PermitNo. L J. -------------•------------ Issued.......................................................
t _
No—tz...=/L_._7 FRs........ c ...._
d THE COMMONWEALTH OF MASSACHUSETTS
a
BOARD Off` HEALTH
f/
.............. 6 -= } V.I ..OF...-. . A ;V �5 7 4 .r��'�»
Appliration for Dispasal Works Tonitrn.rtion rrranit
Application is hereby made for a Permit to Construct (,�) or Repair ( ) an Individual Sewage Disposal
System at:
- .. •... •-•-•-•. ••••• ... - ... =
L ca ion A ress
�y / r t �o
J).," r.i
......................Ef -�7::........ .... .............. ......__.................. .................._._ :...._....._.. ....j.Hr.._.:.5:.- r.--__ �_.. -".'r-`•_••_•_•___
tner - 4 Address
Installer Address
U Type of Building Size Lot_._. .? .-{- ` ..S feet
q
Dwelling—No. of Bedrooms...........: .............................Ex Expansion Attic p ( ) Garbage Grinder
a Other—Type of Buildings'�01'�Z!).M'1'_!''IM4-- No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .
WDesign Flow.................. '...7.................gallons per person per day. Total daily flow__-____ . :_............___.........._gallons.
WSeptic Tank—Liquid capacity;,'YLA _.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------1----------- Diameter......Z_`_.__..... Depth below inlet....-r.......... Total leaching area. :` ......sq. ft.
Z Other Distribution box ( ) Dosing tank ( �)
aPercolation Test Results Performed by � ..............................................................l .. r Date____.`Z.-.1 '// f
Test Pit No. 1_..` ....minutes per inch Depth of Test Pit----J. ......__.. Depth to ground water ...'__O�"'-4- ..
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
94 ._..---- ------.---- .........--
O Description of Soil.....1 c `: ... ft �� ' #3i :-_ S�. ���
U --•-•-•--•-••----...--•----•--------•••-••------•••--•--••••-----------------•-•••-------......•---•--•-------•-•••--------------••-•----------........................................................
W
------------------------------------------------------------------------------------------------•---------------------------------------------------------•----------------------------------------•--
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-I I IE 5 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. y j
it .ar 'S a t` C �f
Signed•.... ! ._w.� :.t_.._. '........................................... -----..........................
' Date
Application Approved B
PP PP Y ............................... ••-----
Date..........._
Application Disapproved for the following reasons:......................
....................................................... -----......-------•--•--------•--•...--•-•...--- ---
Date
9� - 1
PermitNo.---------••--------------�------------------------- Issued_.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....;?.11" ..... w
(Inrfifiratr of TontpliFanre
T,EIJS IS TO CERTIFY That the Individual Sewage Disposal System constructed (",•� ) or Repaired ( )
--------------------------------------------------------•-----------....._.........--------------------------..............--------...--••--•----------•-•--
. Install------- .
at ..� -----"�-3------ .. ..b i.... .-----•.. .. t f�' r,C V/t l
------- -------- ---------------•......-----------------••-•--••--••-•••----
has been installed in accordance with the provisions of "ITTE', 5 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 CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. .L. .. ....OF. r� . .:... t......` .......`...... ...................... .....NO.�,l...../. FEE. fl...........
Disposal Norks Tontrnr#ion amit
Permission is hereby granted-----` ...,1...__.:.:.r6:...............•------•----•-------------------......--------------•---........----.._..................---...--
to Construct (; or Repair an Individual Sewa a Disposal System
at No... ` _.. °...... ��" F ' -,� •'� -
Street �
as shown on the application for Disposal Works Construction Permit Np��� .�� Dated.........................................
00
Board ofHyealth
DATE.................."-•---�-- . ......................... Board
1255 HOBBS & WARREN. INC.. PUBLISHERS
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