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HomeMy WebLinkAbout0137 RIVERVIEW LANE - Health (2) /00a / �� ��,;.b,,..e;. ;.mar--•- .� - v. �,- N •-- ------ Fss............._..�... THE COMMONWEALTH OF MASSACHUSETTS ``gypl� BOAR® OF HEALTH ��. Oca, ...............oF..... 12^n-, ......._.....------.-- 'A liration for Dig os�al Works Tomitrurtiun Vwr t# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1p�Yt mag................. ...... - .................... �/ Location Address � }+� .Aa _1:_...ciRYr`W ....YfS/F.. �� q•� q{.,,� p,�� your L ot NoJ �a...... .4S12....-..... Address ..... Qwnr Installer Address Type of Building Size Lot............................Sq. feet Dwelling—.No. of Bedrooms............. ................__.._..Expansion Attic Garbage Grinder ( ) Other—Type of Building ........................... No. of persons............................ Showers { ) — Cafeteria ( ) � Other fix ures ............1-•-•-•--•` _t9..T 4---------------------------------------------------------------------------------------------------•----- W Design Flow.1JAG'A4 Y4.gallons per person her day. Total chit flow._.......ZZO....................gallons WSeptic Tank—Liquid*capacity.15POgallons Length!P-Q . Width.5,." ..__ Diameter................ Depth_5__-.- x Disposal Trench—No. .................... Wi4h..r................ Total Length........ ----------- Total leaching area....................sq. ft. Seepage Pit Nol�a__PRM Diameter:re._Z__..T.. Depth below inlet.-!;... .... Total leaching area..Z�....sq. ft. Z Other Distribution box (A) Dosing tank ( ) a Percolation Test Results Performed by-��'l.rrYv#-Y. A...19* M T T_..... Datej.i.)Uf._ 10•`7� -1-4- Test Pit No. 1... 3.._._mmutes per inch Depth of Test P ........ Depth to ground water....ZL'Z.- 0i4 Test Pit No. 2-----:!..._....minutes per inch Depth of Test Pit.._....'!.......... Depth to ground water........................ P6 -------- ------._ ----- O Description of Soil.....I`�L M......Yhjl.1010. �.----.��.....-- AV-- � �._�yV x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------------•-••• u 6�FG ------------------------- - Agreement: Sdd.JL'ir• Po 1,,-h�...._.. ��.sr-z-6*rl �-- _�� u/eA—`` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System inaccorZance with the provisions of TITHE 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. c V0 4.1e77 Dat Application Approve By.. . G,/I •-------------•---------..............----•-----------------------.......... /`S..... Date Application Disapproved for the following reasons-------------------------------------•-----------------....----•-----------------•-----..__......------....------ ......................•••--...-•-----•---.........•••-••-•--....-•-••••••-•••-•---••••••---••-•••--•-••••I----••--....-•••••-----••••--••••••-•--•••------------•••-•••--••---•-•----•••......--....••... Date Permit No........ ------------------•-•-_... Issued_.. .`: . .�.�.� .__.____ : �._..._.- �l • --------- .s .... Fizz............... ..........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Uispn,ial lUorkg Towitrurii it Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... ................ •Location-Address or Lot No ._.... a Address --------------------- pe-n u ._:_ 1! F ! c Installer Address QType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............. ___...._........___.__..Expansion Attic ( Garbage Grinder ( ) aOther—Type of Building .......................... No. of persons............................ Showers ( ) Cafeteria ( ) Otherfixtures _ .----------.•-••---•---•-------•--------•-•-------•----••--•-•--•-•---••--•- -••--•......•-•------••-•-- w Design .-gallons per person per day Total dail,,flow-_-_-_-. Z�. .....................gallons. r t WSeptic Tank—Liquid capacity�r..........gallons Length! ".� _... Width.!...._____---- Diameter................ Depth.``?... x Disposal Trench—No. .................... Width.................... Total Length....._........`.... Total leaching area....................sq. ft. Seepage Pit No�# � �= Diameter�?-:�.?�..'t5--_- Depth below inlet..�?._.P'..... Total leaching area..4P-1.....sq. ft. Z Other Distribution box (A,) Dosing tank ( ) aPercolation Test Results Performed by e"t_ n• `1 ... 5� �....•.. Date, Dram . ...r._ 7 a Test'Pit No. 1. i_._...minutes per inch Depth of Test Pit.__._M. .._._.. Depth to ground water._.-E?_D---rvm__. Gx Test Pit No. 2.................minutes per inch Depth of-Test Pit.................... Depth to ground water........................ ------- -- o Description of Soil-•-N = `1'I t YB.re 1 l YG�.� R '= • - - ---------- - - --•---..........5-- w --------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------- ------- U P ..•................•••••••••-•-••-•-•---•-�.------.......PP-•--•---- •.... r'r ; Nature of Repairs or Alterations—Answer when applicable.......................... .......1` Agreement: r_ c ----------- 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 Compliance has been issued by the board of health. f 1� t'Y� ' ,jj �SignedJ............................. Y•j Application Approv B ' . .................................................. ... ...... .....•----•-- ........ nf, = Date Application Disapproved for the following reasons---------------------------------------------------------------•-----------------------------------------------•- ..................••-•••----••••••---.................----•--•-•-•-•-•-•.....--••••-----•-•--- Date PermitNo.......... ---------------------------------- Issued....................................................... Date IIETHE COMMONWEALTH OF MASSACHUSETTS v BOARD OF HEALTH ............ .. .... - '-�- � ...................... Trr#ifiratr of Tompliatta THIS S TO C IFY,That.the Individual Sewage Disposal System constructed (� or Repaired ( ) by... !............................ ;� -------------------------------------------------------------- .....% '1 I alley 10 ............. has been installed in accordance with the provisions of XTLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No � 3�s 7-/S --7_.....•......._ ._..__. _ _ _ __.__...___ a .. ._._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL- FUNCTION SATISFACTORY. ..DATE........... ......../ �' Inspector... .._._.........�P THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F H-E�A,-L�T/H S ... ....r`i'�.....?.............OF...... r ? ✓ �.................................. No......................... FEE........................ Permission hereby granted:'��.'.• ` •-f--•--••-•••••-••..............•----.......•-•--...... to Construct. ( ) or Repair ) n Indi ' a Sewage Di posal Syste6 r J Street as shown on the application for Disposal Works Construction Permit. o__________________ ated.._.7..�5.. .7_�.......... / / Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1-7/5 Tk:/et-1 7 i►oltit 66x - u 5EP7"IC TOti1K3.0 - - "Ali ` Z ASHE"L 577'0A,/E' �kk !_ c v S 5\,y57-zc--14 5z= - 7- o1v Ex!5 riwc 6-Z00n/o eL . 30.o `n � Td p Soil JU/4'IIVE*z� El/E-L yN C-.� o Shy 6oTTOM TrST I-lbz- P 57 C017k; YCL L 0 W WVf7-e/IAE�1 UM Tt) I i CorzeSF 57AA/a 1 � � -' C^'CL4T/ (:)h/ TE- 'c77- r f � •' ram-'' � _ A Six Fo oT' Pi T 1WA s ' AT 7WE- L oCATlON ©F TNE- +�/ R CY L./A/©EFc' /2/NCH D/RME T�� ,. O /G INCH W4 5 /tiI SEreTF- ,9 gA10 �. /- . " �' �- I SAT('xr'//TEL� TD A GREY-TH oF- 1 lr� i"'/ ' -f r /` '/ ✓ FS Cq L!._ON 5 of `I/4 -- TNE- ArsS ok-f,770tQ k`q-rE- - --- { _ 51t4C1IF5 - IM/NU? 5 /©SECCA.IZ S - 5 Jo 50 ryn lZ dam. - 7 do JRCK J. 5YLVIO9 M. �tlFc'MF�N �,'"� -r"�/ ,�A�K J. ` J IR M Y t/ eG X P 1-/YANN 15 /l/1�9 5 5 x 1 J _....✓—` - ! I I- ..ram y e a / 7 / - .- (J IV _ 4 T1 nm _ _-- � 1 ► � ©f ;� i f � / I 1 30 E pric7;�AJ K -N 1 ,� r.tj 1 Lw 00 l _ _ _ -_� •. R 5 5E 5 5 ok'S_Mo7P lVo. 22 8 Tou A f t_5 vRTI o I� :5y5 T��:� -- - c�o -• s f,3A5Ev vr� U 5. C. G. 5 5 1 A4E�nJ 5E- L E vE-L. TE=5 TSUBJECT TO /977 ---- _ RNST BLE .APPROVAL OF BA CONSERVATION COMMISSION r WHITNEY TC n f� . hp SURVELa E. ,osu+� FEf--r I 9WKTN6y - ' JuLY, l 977 �14-r� � iH ; 5I CT50 &,ICII`lEE -S sr�on���,�►