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Home My WebLink About0063 GARDEN LANE - Health (� 3 G-�trdl� Ln., n o s aqa �o�s�oo� LOCH M . SEWAGE PERMIT NO, VILLAGE fit STA LLER'S NAME & ADDRESS®� 142.Co. rc Dcb aw OWNER �sT /9 —7 DATE PERMIT ISSUED DATE C 0 M P L I A H C E ISSUED �� i 1 P i No.. �J..�.. � Fss THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH /" ........OF....................... Appliratiou for Disposal Works Toustrurtiun Vernfit Application is h�eby noe for a Per it to Con ruct ( ) or Repair ( ) an Individual Sewage Disposal System.or . ------..•. ---......... -------------------- ..........-� • - ................ ... ..... a-..-.............................. a on- ddress : or --- .._ ••---- .. ......• . ....... ........ . .. W r w e Insta Address Typ of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms___---- ... _....Expansion Attic ( ) Garbage Grinder ( ) .. — p�., Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) dOther fixtures ----------------••--------------------------....._.......-----------------------•---------------._...-------------------------------------------••--•• 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pa' -----..---- •----••-•--•••••••-•••••••••••••••-••••.....................•----............................................................ 0 Description of Soil...... ---- -- ••-•••••••-••-••••••--••-•----••••••--•---•••-•------••--------------•-----••••----•-••••-............•...... U ••••--•-••••-••••-•----••••-•-•••••••-••••............................••. ..................................... ..._...••••••--•-••••-••-•••-•••••-•---••-••--•••......•-••-•••- ....... � W ••• -•-•-• ---- ° UNature of Re airs or terations—Answer when applicabl _---. 4g�reemeint The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac rdance with the provisions of TITLE 5 of the State Sanitary Code= The undersigned further agrees not to place the system in operation until a Certificate of Co pliance has been i by the board of hea th. Si .......... ---•-•... � -- ---- ----......... ._ . . .. Date - Application Approved PP on BY----•------• ---- ---- ......................... •-•-•-. � ---- Date Application Disapproved for the o lowing reasons--------------------------------------------------------------------------------------....................... ......................................................... •-•-•••---•-•-----•--••-....................'•-••-••-------......---••--•-••••••••-.................................... ----.......... Date PermitNo......................................................... Issued....................................................... Date No......................... FEB/. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD JQF H A! 7H ............ 0 F............................. ..... . ................................................................................. Applirathin for Ropnoal Works Touotrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sysitern-P6000- ........................ ......................................................... ......................:Z:..' ------ ------------------ ...........#_;-f L 66e* q.. a,11...,4kddres� er ..... ...... ................ ..... --------------- .......... -- - ----------- ------- K ... ....................... . .............................. ............................. Installer Address Typ of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____._______________________________.Expansion Attic Garbage Grinder Other—Type of Building ---------------------------- No. of persons__.._.._.............._.__.. Showers Cafeteria Otherfixtures .........0........................................0................................................................................................... Design Flow............................................gallons per person per day. Total daily flow......................................0....gallons. 9 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. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed.b ---0------------------------------------.................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit____._.___.__.__::__ Depth to ground water__________________.__.-. f14 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water._.._______________.__._ P4 ........i!r:=-----------it....................0_........................................................................................................ 0 Description of Soil..............(_e_ .............................................0......................................................................... ...................................................................... .............. ...... -----------I-------------------------------------------- ............................................ X --------------------- irs U -0-------------------------------------------------- of e a or U Nat�reR A�......!4.0-e ` ... ........ ...........Z4......... Iterations—Answer when applicab] ki ........./..0 a, . ..... �'� I ? �'V ;�1. 5 greement. .00 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acyrdece with the provisions of TITLE 5 of the State Sanitary Code de— The undersigned further agrees not to place the system in operation until a Certificate of Co pliance ha been d by the board of health. • IMM.................... .................................S' ........ ---------- Date ApplicationApproved By_________ . ... .. . ........................... ........................................ Date Application Disapproved for the 0 lowing reasons:....................................................................... .......... ------------- ....----------------........................................................................................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ......_OF. .................................... ........................... Tntifiratr of Tumphaurr TH S ISTUXERTIFY T t the Andividual-Sew;, e Visposal System constructed or Repaired by--- .... .....................................6 i .. .. .......'3W ------------- ................... isaz .......................... ........ ............................ On. ta r 1 00 . ............... ...... 7 (ten installed in accordance 1?11 "F,,S of The State Sanitary asdescribed in the r .a ce with&� provisions of TIT it ry C(6 Disposal Works Construction Permit No------- .... .....ap Da �T..........fic�kion fordated- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A _�AfRA GUARANTEE THAT THE SYSTEM.WILL FUMICTION SATISFACTORY. DATE.................. ............................... Inspector........... ............................................................... fr THE COMMONWEALTH OF MASSACHUSETTS BOARQ-..qF HEALTH .............................OF... ................................... .......................................... ........................ FEE. ..................... IN Ja a1purki3 T tr liatt pamit Permissionis hereby gr ted-1.. .......................... ......................................................................................... to Constru# or� ep Indivi al wage Diso� stern a at No. ............... ..... --- �ii• -------------- Street q?s A application for 13 as, on the Disposal ..4 !Ated_ a indi D po al Works Construction Permit .................... Date%--------------0................... .......................t------- ----- ................... ......... DATE.__... [.0.-..*Z. --b o*ar �J�ealt ............................. FORM 1955 A.-IW-SULKIN, INC.. BOSTON