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HomeMy WebLinkAbout0519 PHINNEY'S LANE - Health (2) 5 ( q PI. nr$ys Lane C 8 nfi{CJi�t2 -- 7-3o — K7- 001 N SMEAD No.2-153LY UPC 12934 amead.com • made in USA fOR�TRY WRIATIVE corNBoal�rsourdno �a�rr�Bpropnmoro i 1 I lAo. :. �� Fims ... i� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................... ....................O F......................................---------------------......-------•------------.--•- Appliratilan for Disposal Works Towitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / .:.f.y Aft i/�ty it.i� 64- � ?2 f/! G C' ...................14.7--�----- . . ------------------------........-•-------- Locat n-Address / h © or t No. °..;.��... � ._ ..... ��!_ _�..!? ®!:Tr..._ ..---.r[.`::,l..'I.:tr✓. !s6.'....�fii..l�.�/•--- ---•..__.... --- •----•-•......••............. Owner Address Installer Address UType of Building Size feet Dwelling—No. of Bedrooms.._....�..............................Expansion Attic 0/0) Garbage Grinder Wo) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures __________________________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..l�!?gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench—No..................... Width..................:. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..__ �Cp Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Result Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------------•----•---•-•---••---........................................................ 0 Description of Soil-----. ----•---••-•----•----------------------------------------------------------------------------------------------- x U -••--•--•-•••-•--•----•••••---•-••--••.._...----•-•...•--•---••--•----------------••-------•----••--.........••-----•••----••----••••-•-••----••....-••-----•--••-•-•-•------•--••--------•-••--•••-•••. w . VNature 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 U 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. r- -igne ---- -••- ..-- ...--- _- Date A atin&Approved BY ........................................................... l/p..... � Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------••......_ -•---........-•----........••-•-----------------•......--------•-•--•-•-•--•-•••-----........•------•-•-•......--.----•-•-••...._..----------•--------•-•-•-----•--•-------•--------- ----•••------- Date PermitNo......................................................._ Issued-....................................................... Date lrwYr��ara - -- LOCATION , SEWAGE PERMIT NO. loT / D � ` - -74 VILLAGE I N S T A LLER'S • NAME i ADDRESS e UI.LDE R OR OWNER DATE TERMIT ISSUED 116 D DATE COMPLIANCE ISSUED_ I t i ��sLImp,�S /� l✓� 19 rry No....... •. Flms. ........... f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ---------.....OF.....-----..........--................ Appliration for Disposal Works Tatuitrnrtion Verntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locat d ion- d es or Lot No. .. --.... ,...... .............. .................................................................................................. Owner Address ................. ..... --� ............................................. •-•...--•---•-•-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -------------------------------- W Design Flow.......................... 16.......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trer ................ Width...................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit ..... _ Diameter.................. `Depth below inlet....................Total leaching area..................sq. ft. . Z Other Distribution ) Dosing tank ( ) Percolation Test Results Performed by ---------------------- Date. ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 ' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O9 /V1 =------------••-------....-----•-----------------•---------......................................................... Description of Soil....................................................................................................-•-••••----•-•---------•••••-••••-------......-----•--•---......_.. x U -•--•- UW •-----•-•--------------------------------•------•---•--------------••-••--------••••-•-...••-•••••----•---•----••----------•••--•••----- 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 T ITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation u til a Certificate of Compliance has been issue by the board of health. r / igned"- ... Date lication Approved B / ` may_ PP PP Y•••-•----•-•-••-•--.•. -•--• •-----�==�`_--------------- r[- --------------- Date Application Disapproved for the following reasons-----------------------------•--------------------------•------•-----------------•-----------•---•.............._ ...-•-•--•-•-•------•---------•----•-----•--•-----•---------------------------------------•----.........------------------------------------------------------------------......------•-------••-----•- Date PermitNo...................................................-- • Issued-....................................................... Date `.x. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... t C�rr#ifirate of TontpliFam T.F . L,91$ CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) - Install ' at-----.---- '--- rt( ^� ==�..... ' ------------------�--------- - ---- .----........................... ................................................ has been installed in accordance with the provisions of T "' 5' l e State Sanitary Cad- descr}be ,in the application for Disposal Works Construction Permit No.__........_�______________..._....... dated------.-_ `: )4_....� _._--.-.--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUfICTI40N SATISFACTORY. (� DATE........... .•�• .................................... Inspector...............• •--• f_ -•---- ------. ..................... t v X THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ,.,..•. ' No......................... FEE..............•--...... Biopooatl arks 0ono#ratrtion rranit Permissior> is hereby granted . `... ........ .................. to Cons rut ( ) or Re air ( ) a I ividual.Se rage Is osal System at No. , Jti� 2 �- C.. I !, `� = ---u-------- Str Street _ �r tT7I as shown on the application for Disposal Works Construc 'Qn—P =>i it o._ %....... -Dated__ ....... "".... ..............................................•-------------•••-•-••--- .. q Board of Health DATE------------• ./....` ,. . ---- -----.--••- FORM 1255 A.'�Ivl:a"S17LKIN, INC., BOSTON - Lot o� rp 54,04 ;. . ;4. 50. ®. 54.1 __ ..... 3r2 /9v.B3 Tp,_ Lot S. 3. W 37' L 2f W /¢, 52.9 o cn 3 a 4D. Przi op M p ® S r� =247 S.F rK I I1, 'S49 a. N lS4Q C,S,T'. 52.4- Cr� /ao7 EXR 52.8 �PLAA) SCAL,a H yo. 7ACb ' S2.2 Y Dolt 0428 °40' . 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