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Home My WebLink About0844 PHINNEY'S LANE - Health (2) . � � o �,��,�' �- ��/o� _� � - �� No....jXV___ FPE....A................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,.,-HEALTH . .... ... ........OF...............0................................................................ Appliration for Dispsal Workii Towitrurtion Permit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at:, 10 ................ ......... . . ........ .. ocat, ddr'rs 0 . ......g............ .......... .................. ................................ .......... ...................... ............................... .. ..................A ........... .e .................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder P-1 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria AqOther fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow...... .....................................gallons. � Septic Tank—Liquid capacity...........-gallons Length................ Width._..._._.__..._. Diameter......_..._..... Depth............__.. Disposal Trench—No..................... Width.................... Total Length......_.___..._..... Total leaching area--------------------sq. f t. Seepage Pit No..................... Diameter............._....._ Depth below inlet......_............. Total leaching area..................sq. f t. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1................minutes per inch Depth of Test Pit_....._............. Depth to ground water------------------------ (X4 Test Pit No. 2................minutes per inch Depth of Test Pit-_._-____-______._-- Depth to ground water.___.___.__........_.._. 9 ------------- ----------------------------------------------- 0 Description of Soil-___-_--_-__I ST't-r,�_ ....................................................................................................................................... U ................................................................................. ............................... .............................................................. .**"*------------ ............................................................. ............................................ T Nature of Repairs or Alterations—Answer when applicable.. ............ U A_ 4_� &_ ' 4-414' ...................................................................................................................... ------------------- ------------------------------------------------------------ Agreement:. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 A.�ealth. Signed......—;�r.........e-. ................................. ............................... �.. Application Approved By............ ........ .. . .. ...1- �------------------------------------ ... .. ... Application Disapproved for the following reasons:---------- ................................................................................I..................... ....................................................................................................................................................................................................... Date PermitNo.......................................................... Issued.............----..._....._..........._............---- Date ------------------- --- ---------------------------------------------- No... : ._._._. F$s... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ........ . ... ...OF......... ....:. ............ .-........................................... Appli.ratiou for Bioposol Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .. .... .X. _ =..._.. .....................•-•---- 3Locatio ddress or I of ..................... o. .... � ¢. ¢{. .... P':t .. ................... . ................................(I. ...... = ...................................... a5 �50�7 .....In ............................. .. ...... ... ......-• ........................ ------- nstaller Address W UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------•--•••----•--•----•----...:.._....--•-•-•---•------•----------------•---•-----•----•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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........................ �14 Test Tit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ..._.. fi _............ ........................•___......._.__.__...._._........._._......._......._•____.._......__---.._..-__..._..-__..........- Description of Soil_____________" . ._x 4. ,_ ------•-------------------------- -._..----------------------- ----------------------------------------------•---------------.-----....---........---•---•--•••-••-- _. � U Nature of Repairs or Alterations—Answer when applicable _. . . _.... _ ________________rz_... 44/ s .....................•-•---..........._......._..............._...._.................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 ealth. -• Signed ................................ Date p Application Approved By....... e ��,. -- - ---------------------•-----•----- � Date Application Disapproved for the following reasons--------- -------------------------------------------------------------------------•---•--•--..............__.__. -•-----------------------------------•-•--------------.............---------.............------------......------------......._.......-----------...----------...----•--•--------....._..---------••_.... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF....... .. '` % ....`. ""................................ (Irrtifirate of Tomplianr HIS 0 CERTIF the Individual Sewage Disposal System constructed ( ) or Repaired by..... .... t'` x�. �._• .....•----.¢ ----------------- ^�-�' I„stau has been installed in accordance wi the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................... ............ dated.................................................. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL, FU CTI N SATISFACTORY. f DATE.............. Inspector...... .. r THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH O.... F:.... . ..... :�% I.....----- .......... ..................... No. .:... .......... FED:... ,.,............. Dholva I Works T. °:i trn�tion "rrotit Permissio is herebygranted....... '. ............�°�.�. r�,_:,:._ ...... ...... to Constructs( ) r Re air (,; i Individual -ewage Di.%19 4Syst at No. ...... .... ....... ....... ....... .........��.,'� ... ._. �n ' ..............._............ . Str et as shown on the application for Disposal Works Construction Pan No.. �`e.. �✓ ated-.._.� . .................. �P•:.. pg. .__....�. ......... Board of IIealth DATE---- > --- ................. FORM 1255 HOBBS a WARREN. INC.. K19LISHERS