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HomeMy WebLinkAbout0099 RIVERVIEW LANE - Health a ag/ oo! No YmB THE COMMONWEALTH OF MASSACHUSETTS BG--AR-D O,/F� HEALTH O .p p L4100 T �.N...........OF....... .�'T .T -gJ..f.. ......... � I� ,���r�u�#clan for �t��rn��ai larks C����trur#uQn Frrmit Application is hereby made for a Permit to Construct ()Q or Repair ( ) an Individual SewaZisposal System at: Location-AdY10 ,dddress ..M. .:...��..'l.J �.I. .. :.. 11...D... Owner Address Cepi? .1. _...lnl_G_IQ. Z ---------------- ' - Coa2Y `l'l.Q_t9J__. _ F.uts Installer Address Type of Building Size Lot_�-2� Sq. feet �., Dwelling—No. of Bedrooms.................'J.......-_._--_..___._.-Expansion Attic ( ) Garbage Grinder (}�) Other—T e of Building No. of per ............................ Showers W —Type g (.� ( ) — Cafeteria ( ) a . f ------..3 Other fixtures f- .T -5---•--•--------------•--•--------------------................................................ W Design Flow-l.l-O-6AL/13.� __gallons per person Rer day. Total daily flow............. .................gallons WSeptic Tank—Liquid capacity.1.5OPgallons LengthJ0.7G.-. Width_?--'.�-__ Diameter................ Depth.?-_`7'. x Disposal Trench—No. .................... Wid;h...I................ Total Length........I.......Q... Total leaching area....................sq. ft. Seepage Pit No..ItE7WFtftaDiameter.lk-;.+Z52D. Depth below inlet....'®..... Total leaching area...Z.01...sq. ft. Z Other Distribution box (X) Dosing tank a Percolation Test Results Performed by._.I!�11"1.1T11��°" ........ Date.J ixtf..S.Q �.1g 1.4 Test Pit No. 1....-/Z_._minutes per inch Depth of Test Pit-------1 Z..._.. Depth to ground water....... 4 Test Pit No. 2.......t......minutes per inch Depth of Test Pit---------AA....... Depth to ground water............!9......... a ..........................................................- . . ---...------------•------•------.....----•----•-•-----............----••------ Description of Soil-.....Y En.i-0-M........:T;�............ L' 1 i.,Jr cC-kI'�F► - /�sr�cc��ioc�- Ae&C-rs C--(jIk f d ... -- 1------------------------------------------------------------------------------ -------_.--...... 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 TIT LB 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. Signe J .....;ff . ... y � wSS� 1 Date Application Approved By._�_f� Date Application Disapproved for the following reasons-......................................---------•-------------•----------------••---------------•------...------ .............•---.....-------•-------....-----------•-•-----------•-•-.....------...._....-------•----------------------------•--• ••---••-•------•---•----------•--------------------••-------•---- Date Permit No.------.. .....-- ._. Issued.. ................................................... � Date No.................... FEa..........'.....f J THE COMMONWEALTH OF MASSACHUSETTS BOARD OFi HEALTH Appliration for Disposal Works Tonstrnrtion "amit Application is hereby made for a Permit to Construct ()(,) or Repair ( ) an Individual Sewage Disposal System at: ............ _-- .......... -- ••-------------•--------•--........... ........--•-••----...----• � -•--- .. . - -•---- Location_Address or Lot No o f a11�_6 e I ZQ yId ss ._. �s ------------------ -----------•-- ....... ------------ ---•-•...------. ..._.._...• --------------------------........ Installer Address d Type of Building Size Lot-----------*............=Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ Showers P.1 YP g -------- No. of persons---�-•------------- P ( ) — Cafeteria ( ) p' Other fixtures .............. .. �'� ' _ W Design Flow..QG.A..� �... r",_.gallons per person per day. Total elaily flow............. .....................gallons, R; Septic Tank—Liquid capacity!.a�` .gallons Length!p _46---.. Width` .7.)�"�_t.... Diameter-_-_--___.--•--- Depth. -1•.74.. W Disposal Trench—No. .................... Width............ Total Length..__...r......�... Total leaching area....................sq. ft. x �+tx�A►V � ? S— -Q � Seepage Pit No.___..____..•___._..: Diameter_____________..>.. Depth below inlet._.___._.._._-.-.__. Total leaching area... ----sq. ft. Z Other Distribution box (A,) Dosin .tank ( ) Percolation Test Results Performed by.. ....2.I.�:? `�...--�? `'���':_� ........... Date_' O-r1---L....� Test Pit No. l.... ._._.minutes per inch Depth of Test Pit...... ?'-�..__... Depth to ground water.................... ri Test Pit No. 2......1.........minutes per inch Depth of Test Pit._.......•.!........ Depth to ground water........................ Q+' ..----- ........................................-•-•----------•---••---•-•-••--------.....------...----- „ ------ ---- ._, O Description of Soil---.�'i :?�...�_�'1.....------•�...... C -------..�?..)I v---------------•---•--------------- x W %("3 tf /v '//d L'!C r f'A If1,.Sf (!'/trll /K 1 j/It ,-rttt, f,..[-C - I x -------------- ----------------- •-------------------------------------•-••-- ----------------------------------•-----••--------------------••---•-----•----- V 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 TITI E 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. Signed ...:...._..- y �* Date Application Approved By...... :.. Date Application Disapproved for the following reasons:-------•---------------------------------------------------------•----------------------------•••--------•--•-- ----------•--------------------------•••--•-------------•--•-••--•••---••....----•-------....--------•-------------------------•••-•-------•-----•--•••---••-------•-•------•---•---•-•--•-----••-•----- Date Permit No......... .............................................. �.. Issued._ _. ..._,,.., ........_..__. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ......... .......... (Irr#ifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed '{' ) or Repaired ( ) by.. =!—= C ta''----•---.�t=t//---`-------------•-•-•----•--••---------------------------------.---.----•--------------•-------•---------------------------------"-------- nsta r l at--•-------•------------•-•----••--••......-----•-•----...- /r.t� (, r--- ------/ c rr= 3 Installer has been installed in accordance with the provisions of TITLE E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ......................... dated__..._!.........................7 :.--•-------•-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE--. �Insector_...._ :__...._........................................................... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................. ..........---................................................. No..........!.............. FEE--=......--•--........•. Disposal Works TWntrnr#ion amit Permission is hereby granted...........�~ l •' /r '1 f''C' '_5 --------:: -------- ---- -----•---------------•---------------......--------..............-------- to Construct ( N) or Repair ( ) an Individual Sewage Disposal System at No.........Z....!- 7 /? t, / d. ! �,'' ! l• r/ r r / Street as shown on the application for Disposal Works Construction Permit No........ ..__ Dated.......7.:,.................7.......... ---------------•--------•----•-•-----...-----•-•------------------......------•---------.......------..� -/� _ Board of Health DATE ----------�---------------------------•------------ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' G>i�7�e/ r�o�v tjpx f' -eCOLaT l oA1 TZ-57— - i000 6gL1.DAJ L 6r PIAJG &X/57-/N(7 LU'. JQ _ 7- - RL L 0tJ �--. a7 v �1 7�CfV 501E A 5/X FOOT- �7- wop5 44Rt>F- Nry. 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