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Home My WebLink About0830 PHINNEY'S LANE - Health rrrrrrrr■■■■■■■■■■■■��■■■■■■■■rrrrrrrr■■rrr 4 ��rrerr■■■■■■■■�,, . ,, ��r ■■■■■r■�rrrrrrrrrr■t err■■■rr■■■rrr■■■■■r■■■■r■■r■■r■�■■■■rssr■■r■ ■■■■■■■■■■■■■■ ■■■■■�■�■■■■■■■r■■■r■■rrrrr ■r■ ■■NO■■■r■■ ■ ■■■ ■■■■■■■�■■■■��■■■■rrrrr■rr■r■1' i■r■r■■■■■■■■■■■■■r■■■■■■■■■r■■■rr■■r■r■■■■oo■■i i■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■�■■■■■■■■■■■■■� i■Mr■■■■■■■■■■■■■■■ M■■■■■M■■M■M■UMMEMM■■■■■E MI i■■■rr■a■■■■■■■■■■■■■■■■■■■■■■■■EME■rrr■r■rrrrrI ��■■ ■ ■■ ■�■��■■■■■N■rrr■r■■rrMrr■rrrl' '■■■■■■■■■■■■■■■■■��■■■rrr■■■■r■rr■r■■rrrrr■rrr� ■rrrrr■■■■■■■■■■�■■■■■■■■ r■rr■r�rrrrrrrrrrr■r1 rrE - M rrrrrrr■■■■r■■■■■■r■■rrrrrrrrr■rrrrrrrrrrr i �rrrrr■■■rr�■■r■■■■■■r■■■■rrr■rr�r�rrr■�rrr��rrr�� ir■��■� ��■�■■� r■rrrrrrrrrrrrrrrrrMI lrMr■■■■■■■■■■■■■■■■■■■■■■■■■■■E■NEE■OMEN■ENNEmmI L0CAT10 / SEWAGE PERMIT NO. r�0 ll2nE VILLAGE jINSTA LlE 'S NAME i ADDRESS , 8 U I L D E R 0 OWNER DA T E PERMIT ISSUED v DATE COMPLIANCE ISSUED i �� tits r pt �.No ......... Yzis .............. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ..........................................:0 F......................................-----------------._........._... Appliration for Uiopooaal Works Tonstrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......... ....& !(7/�I..lLL- ..........- .........- -.:.. D L do -Addr ss or Lot No. -� - . ! '✓ — ................... ......................c '! ....................................................... Owner Address W ,... Installer Address U Type of Building Size Lot............................Sq. feet N4 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------•---------------------••-----------•--•---••-•---•••-------•--•--•-•--•....•••--.......------...........--•--------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter--------------.. Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area......................sq. ft. Seepage Pit No..................... Diameter.................--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date----------- ............................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ k, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -----------•------------------•---••-•-•....••-----•-------•--•.....----.....--••--........-•-••-•--.............................................. -......... 0 Description of Soil...............................:....................•-•---•----------------•----------------------------------------------------------------................----------- x U --------------------------•-----.....................----•----•-----.....•--------.......-••-•...........--------•---.......--------------••----------•-••-•-•-----..........-------•-•-••-------------- w U Nature of Repairs or Alterations—Answer when applicable... h Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLE 5 of the State Sanitary Code—The undersigned fur r agrees not to place the system in operation until a Certificate of Compliance has been iss d the boa of lth. Signed F ! Date ApplicationApproved By . -=-.�-......................................................................••••••--- ••-------•-----••- ----•-------. Date Application Disapproved f t e following reasons:-------•-•-----------••-------------•-----•---•---••--•-------------------••-•-•----------------•-••----------•- --.......---•---•......................................................................•---•--------------------------•--•---------••--................................................................ Date PermitNo......................................................... Issued_....................................................... Date --------------- FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF....... ,ai Apli iration for Bispoii al Works Tnntrndinn Vrruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ......... _..!.................... 7�,.....----••----••-•- -------------------d 47*71------------------------_-__----•------__---__--------- � �� _- �" 1 or Lot No. •-••------••................... ner ^_..._.. ...... ............................................... � Address W Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -=------------------------------ ............--------------- Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Lerigth------_----_ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY...........................................................................Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......_................. w Test Pit No. 2................minutes per inch Depth ofa Test Pit.................... Depth to ground water........................ Ri .---•---•.................•-•-•---•-----•-•---------•---•-------•-•---•---•---......-•-•-._......_....----------•-._.......-•-------•---•-•-------•----_-•••. 0 Description of Soil........................................................................................................................................................................ x U ------------------------------•----•---------------------------------...-------•-----••-•----------------------------------------------•--------------..---•------------.....•----•••...__.._._..•••--- x -•-•---•-•--- --------------y:-------•---------•-••-•-•--•----•---------•-•-•--•----••------•---••-----•----•- U Nature of Repairs or Alterations—Answer when applicable.___ _ _____ ��0h_._._______. s ----• ------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned fur r agrees not to place the system in operation until a Certificate of Compliance has been iss d the boar, of lth- Signed. - •-' --•-•• ,.- 1^.. ..._.: , � . Date Application Approved BY 4._./:� -------------- --------------------- ------------ • -•--- Date Application Disapprove or he following reasons-----------------------------•-------------------------------------------------------•-----------------••-'------ ..............•------------•---•----------•-••--...._••----...------=- ...................... - ---------------------------------------- Date PermitNo......................................................... Issued.------•-..._...------------------••--••-•••-•--•----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... %Trrtifiratr of Tomph anrr T' IS,�IS TO CERTIFY, That the Individual Sewa e • posal System constructed ( ) or Repaired ( ) by--- -----------•- - ---•-•-- ---••--------•---• ......... ---1 -�'........................................................................................... A I has been installed in accordance with the provisions of TI / gf�,he State Sanitary Code as described in the application for Disposal Works Construction Permit No.-,___ _______......................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WI FU CTION SATISFACTORY. '~DATE----� ,11 g 3 ...................... Inspector--•---• -••-•---------------------•-----••----------•-•-----•---•---------•-•---.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH UU� ..........................................OF..................................................................................... •! /3 No... ••-t�..7...... FEE........................ Disposal Works Tnntr ion rranit Permissionis hereby granted.................. ------•--••-•----•-•--'---•------------------------------------------------------...---------.._.__._._..........••_.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the 7tv 'ion for Disposal Works Construction Permit N ___________________ Dated...................................... .................... ........'---•--•--- -----•-••----------••---•-•-••-•-'•-------________...__....._ Board of Health DATEI •---•---•-----•----••---•--•-----------•-----------••-•--•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS