HomeMy WebLinkAbout0520 PHINNEY'S LANE - Health 520 Phinney's Lane
Centerville
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No. H 1630R
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CATION , SEWAGE PERMIT NO.
VILLAGE
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I N S T A LLER'S NAME A ADDRESS
C\ e U I L D E R OR OWNER
DATE PERMIT IS'SYED
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D A T E COMPLIANCE ISSUED 6 1,-5
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. ........................OF...............................................------
Appliration for Disposal Works Cn mitrurtion Prrutit
Application is hereby made for a Permit to Construct or Re air an Individual Sewage Disposal
System at:
........................ .!:��....... -------
Location-Address or Lot No.. ................................... ............................... 2q74.,
Own Add
W kuk4s
....I��V.:5 7/.................... ..... -------------------------------------------
Installer Address
Type of Buildi�� Size Lot---S-7-- Sq. feet
U xT
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
aOther—Type of Building ............................ No. of persons............_........_______ Showers Cafeteria
Otherfixtures --------- ...................................................I........I...........................................................................
Design Flow.................. _.......__...__._gallons per person per day. Total daily flow...............5352..............gallons.
9,-- Septic Tank—Liquid capacityib.O.O..gallons Length---------------- Width__...........___ Diameter__.__.__.._..... Depth................
W_ Disposal Trench—No. .................... Width.............____... Total Length......_............. Total leaching area....................sq. ft.
W4
Seepage Pit No----j..0.0,0------ Diameter......A-------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosin&.
_tajik
Percolation Test Results Performed by.... ��......................... Date..2_-!:L—a ...............
Test Pit No. I........ ......minutes per inch Depth of Test Pit------I-Z,_ Depth to ground water..__..ltlk>tk------
44 Test Pit No. 2................minutes per inch Depth of Test Pit........!�......... Depth to ground water._....__....._......_...
9 ...... .......................................%.................................................. ..........................
0 .-,o ', , —
..................... .....at...L,
Description of Soil-----------C) ..... ....410.... ;0...
----------------------------------------*------------------------------------------*-------*...*---------"-----------------*............................................................................
.......................................................................................................................................................................................................
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'LI'IU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be# issued by the board of health.
7a
------------------ ------
Application Approved BY---- .... .........................................................
.......... .........
ate
te
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
---- ------------------------- - --
'
Fmc..............................
� THE COMMONWEALTH OF M-AssAoeussrrs �
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| BOARD OF ������U -���
.................. -- ................OF____________
�� �� ��
' . Applirvtmou» �� mwlins«� Nor
"oustrurtion V"erutit
SystemApplication is hereby e r a Permit to Con truct or Re)air an Individual Sewage Disposal
� Installer ~ ���" �� "� 2� ^ -
��
Type of Size feetI)vv��o0--No. of Bedrooms............................................ Attic ( ) Grinder ( )
Other—Type of
Disposal Trench----rPL,4b0.0................. Widtiz.............. Total Length.................... Total leaching.area..............*.'.'.'-.sq. ft.
Z Other Distribution box.4 ) u000ng���ur�=�p~
~~ }`ercnudoo Test Results Performed by---------------------------------------------- ..-------. I)�e-----.-----' -
Test Pit No. L'-..........minutes per inch Depth of Test Pit.................... Depth to 870006 water........................
rX4 Test Pit No.
-- _........................-.------__-------'---------'�........................ '-'...'~'~-'~~-~~°~^~-_
0 Description o{ Soil............................................................................................ ..........................................................................
| U ' ------'---''---'------'----'-'----------'-----------------------------'-'-----------------------'-----
----'---_--------__-...__----__-------__.-_----'_--._--_..__'-_-____'_'_-.------'_--_
U ' Nature of Repairs orAltcrutionx--Aoowezwbeo applicable-----------_.----------_--.-.--.-----------
'__-_-''-------.__--_------------------.----------'------------_.-----'------'--------.------'-'-_- �
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