HomeMy WebLinkAbout0339 RIVERVIEW LANE - Health 339 Riverview Lane
Centerville
A=228 — 195 - 002
NUP2183L0 �
/,& �,', �j 4 rxe -&:�) N
LOClk T ION SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME A ADDRESS
rc
e U I L D E R OR OWNER
DATE PERMIT ISSUED ` ._ & y _.
DATE COMPLIANCE ISSUED
r
G
Y-3
NoJt— Fzz..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR®
OA R D ? . E. ALTH
01�.Jj..........OF......... . .. ... . 111 ------------------------ .. ...
Appfiration for Dispasal Works Tomitrurtiatt thrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.11-c*/, W... .. .......... .. Lo -aui-6fuju6
.Z _.q (411t) . .......................................................
Lo a ion Lot No.
'i 0,
. ........f aLo!!k�l
............................................. ............
,......................................................
.... 0 nLr Address
r�
.. ..... . IS --- ------------------ ----------a-w- ------------------------------------------------
Installer Address
Type of Buildin
Size Lot......L� _i1X-Q.Sq. feet
U Dwelling 0. of d, Garbage Grinder (k%)C,
Bedrooms..............13.......................Expansion Attic
Other—Type of Building ............................ No. of persons........_.__........___.____ Showers Cafeteria
Other fixtures .....
;,;-�---------------*-----------.........-----------------------*-------------------------------1__-----------
Design Flow........................... ......_..gallons per person er Jay. Total da.Ay qow..................-,i3z. ...........)9pons.
.6------------------------
9 Septic Tank—Liquid capacityl=. ..gallons L e n g t h.-V-17'.6..... Width--Y--,/L)... Diameter________________ Depth-_ ---
Disposal Trench N o..................... Width .......... Total Length ... Total leaching area....................sq. f t.
Seepage Pit No_____________________ meter......... Depth below inlet--_-- ._....... Total leaching area .....sq. f t.
Other Distribution box Dosing tank I ) I, 4
I ....... %._Z
Percolation Test Res is Performed by.......liz t ti Date... ................ .... ............
Test Pit No. 1-?;::.:��.minutes per inch Depth of estr__ Depth to ground water....0
Test Pit No. 2................minutes per inch Depth of Test it... Depth to ground water_._....__.............___.
all......./------------ -M!!Af -------------
0 -sxg%, ................................. .. .............
Descfiption of Soil--- ..... .. ..........
....................................................................................................................................
------------------------------ ...... ....
.......................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
.........................................................................................................................................................................................I...............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of THIPLE4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complian has been oedatheard of eal.th,
Signed.....(V/..... ... .............4,1.1
Lf------- ....... ........................... .............
e Z
Application Appro ...... ....e................................................................................. ..................
Date
Certificate
re 0' '_omp
T han Signed
------ ---- ------------
110wi
ejo Application Disappro If he following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
s
No w . -• Fx$�0........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiun for Disposal, lVorks Tonstrnr#ion .erntif
Application is hereby made for a'Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
��t5 C,ir .. 11!"V I� �..,tJ..: •----....-----.......•••-._.......-...---
Location-Address - or Lot No.
- . �... ...... ................................................
Owner Address
a .....A......-----•..._..._....•--•---- ... ............................................. ..---•----••-•-------._.._.....--------••--•------•--........--•.1~..----••---••-•-••......_.
} Installer Address
U Type of Building Size Lot..... -'�?_Sq. feet +
�-, Dwelling '`�No. of Bedrooms_____________ .___._______________.__.Expansion-Attic ( ' ' Garbage Grinder'I�Q)3
p l Other—Type of Building ____ ____ No of,,per'sons_Y ______________ Showers ( ) — Ca_feteria (I )
al Other fixtures .. /__ � ._ .____ '
II ----------- ••..._------ d ...
Design Flow__________________________ allons >* fs 50 a� ��ta_,��
I flow.._--..__.______. --••------------- Ions,
g - g l Y > �
WSeptic Tank—Liquid capacityhy.j?...gallons Length Width.Y_._&____ Diameter________________ Depth_ 1..._-
x Disposal Trench—No_____________________ Width___._.._.______.__. Total Length________=__I_.___. Total leaching area__�_.______________sq. ft.
Seepage Pit No______ _____________ ameter___._.._Y.-__..._ Depth below inlet.___?_._....._. Total leaching areal o__.__sq. ft.
z Other Distribution box ( Dosing tank Q ) i
'-' Percolation Test Results Performed by------ (".1 ( 1 �`- _______________ Date._
,.__.
M Test Pit No. 1 K.___:T:__minutes per inch Depth of. Tes P't_._._ja�__________ Depth to ground water_C�v _�_____� . �
fs, Test Pit No. 2................minutes per inch Depth of Test it.................... Depth to ground water........................
----•-••-
O Description of Soil + 1 1 tk, 'f !.%f;` "" ' -) -7� A -7 '
-•-•-•-
fl-J� -� ' t-°-�'•.----•-•••-•---------•-
---------------------------------------------------------------------------------------------------------------------------------------------------------- ............................................
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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complian e has been • ued ,y the oard'o health.
l
Signed. ------------------
Application Appr<ge, ----:' ----------------------•-----••---•----........---------•----........... -----•--------
Date
Application Disappro d f .''th4
e following reasons----------------------------•---------------- - -
•--------------------------•---------•....----•-------•----•---------••------•-------•--•------•---- --------••-••-
Date
9 Permit No............... _
•--------------•------.........__...---- Issued.------••------• ---------•--•------------•-----•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........7`` Is!/N ...OF............. ..............................
Trrtif iratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (✓) or Repaired ( )
Or-
by---•-----'=pu-'F------C.0:../Ar..... 7c_n--------------------
------------
�s,/� Iristaller
at t f..y. j �� _l.Ut_✓..�L__4'�------ !1_ lC✓_ 1...
has been installed in accordance with the provisions of T T F 5 of The State Sanitary Co a�e- ribed in the
application for Disposal Works Construction Permit No._-__'�I '_114_____________________ dated __Jr/_d=__�.._________-...__________.
THE ISSUANC OF THIS CERTIFICATE SHALT. NOT BE CONSTRt E AS A GUARANTEE THAT THE
SYSTEM W. I KF NCTION SATISFACTORY.
DATE_Y _---------•-----1�---------•--•-------------••--•--•------••----•--•---- Inspector... `.._.. --•-•-------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
���.. FFE
No ...:....... ........ FEE.__......-----..........
Rop000l Works �ono#r iun rrbti F
Permissionis hereby granted-----------------------------------------------------•------•••--•--••-------------•-•-----------•--•---....-----••-•---..........--•••......
to Construct (t/) or�,Re 'a r ) an Individual Sewage Disposal System
atNo........ .......................Y`=-----••-----._..._.
-•---
Street j
as shown on the application for Disposal Works Construction Permit No.�-p ___.__._.. Dated 1____________________________________
.._.........•------- -••-- -----------------•--
Board of Health
DATE_ .. 3••_• y............. e
J
FORM 1255 A-.M. SULKIN, INC., BOSTON e
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OW , lip 3 = 73o6pD .p
PT1G TANK 330x15�"/. = A9i6.P. �� 10�
• : � . . uSE._ ►000 Gat.
t�►5Po5�L P1'1' v6E 1000 6AL. .1k
I 50TrOM ' lAcLEA: . �o �►_. J
3 it 'TOTAL -DESIGN 1 �}25 G.PD., �4 �t
1 II ioTA1.. 1.VAIt;Y F1-OW = 330Cl,PO,
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it la OF�gssrfi t i `N OF 1000 G ��
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