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Home My WebLink About0020 GINA COURT - Health 20 Gina Court ' l 210-19.2 Centerville i Wol 469 MAIN STREET, CENTERVILLE A = 208 085.002 UPC 12543 No. 53LOR HASTINGS, fAN #113�_D � ; 31 LOCATION SEWAG PERMiT NO. L._ ;e_lR 1c� (5:-1 A,, V I L L A G E F,-;,-n -'' 'r I/ ,INSTALLER'S NAME i ADDRESS 1910A,6 F 1 l d U I L D E R OR OWNER S d� grit DATE PERMIT ISSUED — � DATE - COMPLIANCE ISSUED 71 3� '6 37 M 8 03ns,s1 13NVIldW03 31V0 03nSS1 1IM1113d 31V0 N3 NMO 80 113 0 l I n N SS31100V T 30VN S.M3ll V1SN1` P.4 4xvmkA9 3 9 V 11 I A 'ON 11w113d 9VM3S `b NOIIV301 J j67�r t r i �Y v 4'. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH . .' �?..f�................O F.-.-......Z o.P-..f\..SA-C> Application for Diopoual Works Tonotrurtion ramit on is hereby made for a Permit to Construct ( ✓f or Repair ( ) an Individual Sewage Disposal stem at: �� •-•-• Cnic� .. --._... COW ...... ..... . Location-Address or Lot No. . ............ I...•-- `=---•----5.....\........................... ............ .- ........................ Address a .............. _k gn.�Va-•••••- e •--• -r, , ......_...-•---•-•••••-•-•••••••• ---•--• n-- -............................................. Installer Address U Type of Building Size Lot...�S_ 0 373......Sq. feet Dwelling—No. of Bedrooms..............3...........................Expansion Attic (tl®) Garbage Grinder (n-) Other—T e of Building ............................ No. of persons____________________________ Showers — Cafeteria a Other fixtures ------------•-• --------------------------------- W Design Flow......:.........0,.Q_.....................gallons per person per day. Total daily flow.......... 3_ `'_____.._________.___gallons. WSeptic Tank—Liquid capacityAga_ogallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ IAidth.................... 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 1:ko CA......`z4.....SLY.-_______________ Date....5-N5-'.Q?L............ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water....................... fT4 Test Pit No. 2---.............minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............ ---------------------- ----------- ---- Description of Soil--------5�-...z� ......�-.......�S4.�M.--•---...a ��-Y 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 TITI a4 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. Si C7...�P � / D e -----------•-•-•-•--- --------- Application Approved BY _ = - �Er- - �� /L Application Disapproved for the following reasons_______________________________....... -------•-•----•-••---•--------•--•-•------•--•------•----.Date----•--------- --•-•-•-•-•--...-•..............................•------------•......-----------••••-•-----------•-•-----•--..-..----•--------•--------•------------•-------------------•-•--------_-Date---------- PermitNo......................................................... Issued....................................................... Date Fimic 3.1p.... . THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEALTH (1-.."; OF...........C'.f.n `.. c`� ApplirFation for UiipoaFal Works Tonttrurtion rrntit Application is here�y made for a Permit to 'Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: ...............C? r\c: �c �� •-`• - � �.._....- .......... .....__................... .._. .............. •--.........•--...........•••-_. ... .--- -----------. .... Location-Address or Lot No. M♦ Vim+ \ �\�� . \, �b Owner Address Installer Address Type of Building _ y,, ` Size Lot... ......Sq. feet a Dwelling—No. of Bedrooms............. ........................... Attic (f\,�) Garbage Grinder (nJ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------•--------------------------•------------•------•-••-•-•••••-•--•--•••-••-•-•--•----••-•••-•••-..............•-•-••••.........--•---•-------•- W Design Flow...............1N.v.....................gallons per person per day. Total daily flow___..._.._-? 3_.........................gallons. WSeptic Tank.,—Liquid capacity..�:v_vgallons 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....... .�v:C-N....._`� ``- 5 �C�.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ........................................................................................................................................................... O Description of Soil------`•,- \` •-•----1 .......`".- .......... -------- Ux ...........•••---•------•-•-•---••-•-••-...!Z:.•..'-----•�• `�' n_c�-�1.. ` `�----•-••. W -•••--•••••......................••••------••---•••------•••-•••-•......--------•...•-••-----•••-•-•--......----•...•--•••••---•......----•-......••-•nJ••• `'-'-..... 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 TITIE 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. Signed �='-----`---------- ------------------- --- �:-\\_ �' 1 Date Application Approved BY 'W...-- ----,6% ---------- Date Application Disapproved for the following reasons----------------•-•---------•---------------------------------------------------•----------------------........_ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ti!.?......................OF.,.....k . t`1(1 .................................................. Trrtifiratr of TontpliFanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by........ ti)r L�. .�._�:--------••-- ---•----•-•.....................•-------••-•---•-•-•-•---••---•--•----•-•---•--•--...............................-----...---- ` Installer (� has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.- .y .. _1.44............... dated--------------------------------------.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................llf,1-51.-----•--_. Inspector..--.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / �; ..OF.---....... ........ .C. ............... T3• FEE.. U-.......... MoVagFal IVorkii Tonotrttrtion rranit Permission is hereby granted------... ......... --.........................-............................................... to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo-••••-••--••l......•. �_l-•-••........ • ^ `-=-----------(-F�I k.k.----------------- ,.-_-.-.................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... r•� y� ter-- ✓ L�/� C ••..;a+•iY: r ealt ....----•......................•..._ B DATE.................. f J--------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS h ,,+ 511.LGL�,�.�y'L1M11.�( - `3,�•l��GC�N� � w i �i � � 1.1� �-sAi�=PLY t=: C>I.�I IJGE-:5�• ' I I 4t` 2'.),&tLY F=uovu a oo -4 S • Ss�/ o G.P.V. 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