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HomeMy WebLinkAbout0354 PHINNEY'S LANE - Health LOAL Ice 1\-wvll It 230 - t 61 ------------ ---- a M E A D No. 2-153LY UPC 12934 smead.com • Made In USA �J 2 11 0 SUSTAJNAM FORESTRY INITLWK Certified FiberSmira6W w.w.afio�oonsdo 1 1 i 1 1 III C T ION SEWAGE PERMIT NO --&Z? VILLAGE INST LLER'S NAME i ADDRESS e U I L D E R OR OWNER DATE P E R M I TZI ISSUED DATE COMPLIANCE ISSUED � 1S t 40 ... -3© - F . (J �j L.of 1 1 �... No.. y... ._ �► THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH , r ............ .....OF ..."hAKt,1,FPAKW�MAM.LE............................ , ppliration for M-4potiai Worko Towitrnrtinn 1hrmit Application is hereby made for a Permit to Construct 00(4..,or Repair ( ) an Individual Sewage Disposal System at ...... �- . �.±�i�t :.. ... --------- ............. ........................................................... Location-Address o --- No. . w.. :... ----------------------------------------- .. •a__- ,Wa@ st AddressOwner ller Addressa ------------------------------------------- Type of Buildin Size Lot_U..) ......Sq.hfeet N U _..._E ansion Attic kit ` Garbage Grinder l � ; ,� Dwelling_No. of Bedrooms___..._ __________________________ pa Other—Type of Building ____________________________ No. of per, ons............................ Showers ( ) --Cafeteria dOther fixtures -------------------------------------------------------- -------••-._..........------------..__...-••---------•--•••--......----•------•---•--•-----. DesignFlow............. ._..gallons per person Ber a Total daily flow__._...._. W g P P e . , ai Y - 3 --------------------gallons. `\ .W Septic Tank—Liquid capacity.10M-gallons Length__ Width"�.----0... Diameter................ Depth--' n-—(p. r( x Disposal Trench—No..................... Width.................... Total Length---- Total leaching area....................sq. ft. + Seepage Pit No.-------- ----__ ... Diameter._...12....... Depth below inlet---- ---- Total leaching area..Z..j---sq. ft. Z; Other Distribution box ( Dosing.tank to Percolation Test Results Performed by.'re _...!:?-lv Test Pit No. 1.42------minutes per inch Depth of Test Pit--..11..........._ Depth to ground water...ID'-�*VI-OCTSP 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water....�..�.. ............t---- -•---- . •--•-•---........................r....-----t -- ..... _ 0 Description of Soil.........0. �--•---- A�--... _ ._.....O `--�-----------� � � ��� � rx" --------------------------------------------------- -04D---- �.�- . 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 pro ions of 114.L p 5 f the State Sanitary Code— The undersigned further agrees not to place the system in operati until "tificateCo pliance has been issued by the board health. . pIg F ,�-y�� � Datpli tin pp G.:..:..d_.!..... .._••---- ' �` Date APPli on Disapproved for the following reasons--------------------•------------------------------- ------------------------•-----------------------------.----- --....•----------------------•--•-••--------•--------•-------•---•---•-----------------•---•---------------•-•--•------------------------------••-------•-•--•---••----- ........................... Date Permit No.....<Oa—GDc7 Issued-....................................... -------•..... Date � y� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ®w..t-4.................- -OF.. .t5A.R.K•5T. L- ------------------------------ Appliration for Did#mal Warks &mUnrtilan Vamit Application is hereby made for a Permit to Construct or Repair ( )' an Individual Sewage Disposal System at: - ..... - -1• •t J - -•- •••••--....�_ '_�. __............ ................................................ Location-Address •No. _ Ia,-L-.................................................... ...............................................A 12CIA. .....:.-. Owner Address L9 flea nstalle. Address Type of Building,. Size Lott-�_�1 9_0.._____S f et U � q. Dwelling No, of Bedrooms._--- ---------------------------------Expansion Attic b) Garbage Grinder :;, aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) POther fixtures -----------------------------------•--------------------•••----•--•-•--....•---••••--------------•--•••••....••-•---••-•..._•----••-•••-.......••-••- W Design Flow............ 5!----------------------gall ons per person per day. Total daily flow......... _---------------------gallons. W 41 Septic Tank—Liquid capacitylOW gallons Length '_f�___. Widt14�-'f_0.... Diameter________________ Depth_ —_9_ I' x Disposal Trench—No_____________________ Width.................... Total Length.._.____........... Total leaching area_._.................Sq. ft. Seepage Pit No------- ------------ Diameter____1 ........ Depth below inlet_ __ _______ Total leaching area _. ....sq. ft. Z Other Distribution box ( ) Dosin- tank ( ) '-' Percolation Test Results Performed by s. !!! Y�.�a s.A_ 1 --�?.f_[` jE.jlJL. Date__._�Q°_ '__�_..... __-. p p 1 p g .�� "Ta Test Pit No. l _:.,_____minutes per inch Depth of Test Pit___________________ Depth to round water__1£ _.... ._ _ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___ g' _----------- _- O Description of Soil-------- e 1 � 4P ._5`.._,Q- -- --- & ' -? L -------------------------------------------------4�Ceo vv45-------`�= ?_ 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 ('.L�X the pro ions of 4' I,t, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operati until a C tificat �f Co pliance has been issued by the board health. Signed----- �". �f-.""z-------------- Da( pl' at " p roved By.: '�� �1_.: :" ' Date Appli on Disapproved for t e following reasons:--•---•----------•-•---------------•---••--•----•-••---••--•----•----------------------------------------------- ..............................::........................................................................................................----•--------------------------•----------•--------------------- Date Permit No....... ......................... Issued.................................. Date - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................... Trdifiratr of Tiantlrlianrr THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........... !- -•----------------•----•----- Installer has been installed in-accordance with ze provisions of T I T i 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated-----------------------_-_...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO Rl1E® A GUA NTEE THAT THE L--SYSTEM WILL.FUN TION SATISFACTORY. � .r DATE. _��- ..� ...... Inspector...:._._ --•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ! g ..........................................OF..--.......-_..._...._.._.-_...-,._..-....-._._....----------------..._:_.._.... FEE... , vio-posal lgorkii Taansirrndion rrntit Permission is hereby granted.....4,r:n�nk to Construct (� .) or Repair ( )pan Indiialewage Disposal System tl at,'No...... -1 .�..------..��r--�---- = `*�°`-•----- • �� Street s shown on the application for Disposal Works Construction Permit No._��._'t__�_'-_��3 Dated_____ _ l ...................... Board of Health �DATE............ --- - ---•-----•-•- FORM--1255 HOBBS & w RREN. INC., PUBLISHERS i aI�JGt� FAMILY P�Eoct�oM SMEcr 1.OFZ, uo GACESAGG DAILY FLOWI JLsla3oxi5o•/3�A9 � G.P � SEPTIG ?ASK j*=.L= ?L A 0 fie.► use lOoo GQL• OISPoSAL PIT L)Sir b oo Gems. S mE\4/ALL AICE'4 ►32 s F A 3eT'cvM AtcA = Ii313�GPo 11� S f x %.o TVTAL 'Ds5%"u = A43GVD F%--ow •330G?D P62GOLeTION RATE I'�ily ZMIN o trESS C. YE iYQ i'3: {4 S G= qZ.o Tov cut, •r x �� Imo•40 0 Ieou 111�l. L� GsL• D,ST. IUJ s,.j Scn.tG Jl. L6hCU INv. INV. 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