HomeMy WebLinkAbout0211 RIVERVIEW LANE - Health 211 Riverview Lane y
Centerville
A= 228 - 095
UPC 12534
2.153
NAYTINO�.UN.
TOWN OF BARNSTA LE IY
LOCATION Z// /°�l�I�Jl��t� . /1.�'—,-� SEWAGE #
VILLAGE ASS SS R MAP & LOT 22P lh)
INSTALLER'S NAME & PHONE NO. ®U4 — t 32 T 0,00
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type)�L CI S (size) Idoo d-
NO. OF BEDROOMS .3 PRIVATE LL OR PUBLIC WATER Lv
BUILDER OR OWNER C�W a,
DATE PERMIT ISSUED: 1!Z0 y
DATE .COMPLIANCE ISSUED: t7y V -r A/ 7Y
VARIANCE GRANTED: Yes No "�
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LOCATION L o+ CZ 5EW6,64E PERMIT UO.
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BUILDER 5 Q &MF- �- ADDRESS
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Db%TE PERWT ISSUED
D ATE CONMPLI &I ACE ISSUED;
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No.....P—7-6...... Fps:.: Cl.:............... a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?_"_n . ------.OF....40,. .�.. ..:.....
Applirtttinn lvr DiipniiaI Works .T1116trurtion rrntit
Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal
System at:
([ 1�1 V ElP.•---�d� �.------��-f.3� �--11L�-�----------------------------� ----�--��----
- Loc ti - dr s or Lot No.
Owner Address
a ....1 -? _... �Otl,QC9 1--------------------------------------
Installer Address
d Type of Buildi�n�/ Size Lot....t j.15 o.....Sq. feet
U Dwelling Z No. of Bedrooms--.__LA7 G7---------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtures ----- --------------•--------------•-------------- ........................... .-•--•--------•----•-----
------------------------------------
W Design Flow...............t.�_ ?_..__.._.__...........gallons per person per day. Total daily flow-__-.--_-__-_. gallons.
P i Septic "I'c.nk—Liquid capacity_ OaU_gallons Length------ Width........ lliameter__......._..___ Depth._...._....-.-
Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area...------_-__--.-.sq. ft.
Seepage Pit No.....TWU--- Diameter.....8----------- Depth below.inlet_...... ..._... Tot11 leac uIg a a... -----sq. ft.
Z Other Distribution box (>O Dosing tank
Percolation Test Results Performed bY----------------------------------------------------------------- Date..... .--t----- - ..
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_.. D..._......
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.---.--_--.--.-_--____
P4 .............. --------------- ---- Z----------
W -Descript on of Soil...._._._ _ ___ _______________Y - _ � �/L_
_ _
------------
------------------- - ----------------------------- ----- :--- = =
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 NI of the State Sanitary Code:—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has, e :b-} e boar-d Qf alth.'
4�Sig ---•--- - -- ------------------------------------ -- ------------- ----------- = ...
Da
Application Approved B
PP PP Y Lr !j- � 7
ate
Application Disapproved for the following reasons:----------- -------------------------------------------------------------------------------------
--••--•---•••-••-••...----•-----•--•--••-•-------------------•-••......----------•-••--•••---••-•--•--•••-•---------- ............... ---------------------------- -------------------------------------
Date
-
Permit No......................................................... Issued------------------------- ---•- .............
� 7q
Date
No•-_:1 74-----•- FEs.
..........
THE COMMONWEALTH OF MASSACHUSETTS
` . BOARD F H ALTH
O F.
ApplirFatio for Di-g1 sFal Works C onstrurtioaa Vrrnift
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at:
Loc ti dr s or Lot No.
=L ` ----1� /�cs-------------------------------- ---------- ?A _1 1 ,�,...._5 1 .. HY/,1.1N."5
Owner Address
,a
- '----•-•-------•--Installer Address
Q Type of Buildin Size Lot...l2_,35 .....Sq. feet
U
Dwelling No. of Bedrooms._____QF.._6-----------_----Expansion Attic ( ) Garbage Grinder ( )
aYP g P ...... Showers ( ) — Cafeteria ( )Other—Type T e of Building ---------------------------- No. of ersons_----------_.._._.....
a' Other fixtures
WDesign Flow................' ?._....................gallons per person per day. Total daily,flow---------_-_ --------------------gallons.
r4 Septic Tank—Liquid capacity_kOWgallons Length.....8_'_____. Width------ Diameter________________ Depth,---------------
xDisposal Trench—No. .................... Width-------------------- Total Length--------------------- Total leaching area--------------------sq. ft.
Seepage Pit No _1J0_.. Diameter..._8------
Depth below inlet ____ Tot 1 le c n_g a a___25_I-----Sq. ft.
z Other Distribution box ( ) Dosing tank ( ) e rC .:T//'� r
aPercolation Test Results Performed by..........................................................................
a Test Pit No. 1________________minutes per Inch Depth of Test Pit..._--__•_-_-______- Depth to ground water..y0.__.'F._..._.
LT. _ Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__.________;_--_____.._.
....... ... Z--•------ '..........................
Description.of Soil,_.___.___ _,....•
- /`y -E -;------ -----------
W
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------:....................................
._...
r• t
Agreement:' . ._ t
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ArticlesXI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until aCertificate of Compliance has
ZQeboh
e b rdf lth.
Dat
Application Approved BY .........%_e................. ...y_
cr
Application Disapproved for the folfAving reasons:---------------------------------------------------------------
--•-••-----------•...-------••-••---•••......--•-
r-•-••----••••..---•----••------•----------------•-•-•--------••-•-•-••-•-•-----••......-•--'•-- -----••-------;------------.... ---• -----���---------------------
Da---- -----_ r: te
Permit No.............. Issued._._!.... •--- ==
Date
w y. 3 � d
TH'E COMMONWEALTH OF• MASSACHUSETTS
BOARD OF HEAD:
O F........ Q, y1.:.... t
- ; .0fir�atr of f�nran littatrp
TH I TO ' E I Y,. -iat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by------- =----- ----- ,---------- ----------------------------------- ---•--•----------------
` " a Installer /y�f^" A.,�
at ._:... rs.L• r]rGf� T—r'A -----------•..............•-----•-•---•---••--••--•--•-•-------
------- - -has been installed in accordance with the°provis>ons Mof':Article XI of T e State .Sanitary CVARANTEE
s des bed,in the
application for Disposal Wc(fk� Construction Permit No..._.._....._�7_.4........... dated.._.( cTHE ISSMANCE4OF THIS CERTIFICATE SHALL PLOT BE CONSTRUED S A G THAT THE
SYSTEM WI
L NFU" yCT O SATISFACTORY. -
... DATE' f ................ Inspector �� ---- -----------:--•-------------........•..._...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ . .......OF........... . .. . ,- -- K G' ............. ® 0�7��
k No....o2:.��..Lt. ---/ -._ FEE -----------
Y,4 BinVwi Marks, n mitruruou Vamit
a
Permisston t hereb Fanted--- . . -------•-••-------------- •-•-••-•-...._._....
Y g, _ x
to Construct ) r parr ) an huiivi&VaI S wage posal Sys
.. Street
' as shown on the application for Disposal Works Construction it No.
- = -__ Dated------ ------=-- ---------------•---
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-- oar Hof Health . -
DATE....
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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