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Home My WebLink About0018 GINGER LANE - Health �� 01 ,� � 707 L O CATION SEWAGE PE"RIRIT NO. / s VILLAGE _ C 16s a � S INSTA LLER'S NAME . i' AOO,RESS . . a u I L 0 f R OR OJILN E II ,DATE PERMIT ISSUED DAT E COMPLI-ANCE ISSUED r . � .� „�✓ r,�� :+ �� _ �� ,� �� i � �� - . o�-� �C'_�L3 C�Ss�pa��. /o�G G�j � . � No..-........7�...... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® 9F HEALTH .....OU ,1....--OF...... . Applira#ion for Disposal Works Tonstrarrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at .... .. x� . ... -------------------------------- -- -- ----------........ ..:_--------.............------ cation-Address Lot No. . ----------------------------------- ---------- . .......------......-----------.....-...----- dress .-----_. ------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other 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 a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Wq______________ __ _ ___ ________________I .. ......................................................... O Description of Soil-_---- .... ...- x V --------------------------- •------------ ------------------------------------- _-____---------------- ------------------------------------------------*--------------- ------------•------------- W --- ----------------------- 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 MIL- 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. e��, Signed-..... 0 = a�� ----• AA..AID, Application Approved B 4%.___ .R _ ate PP PP Y J `'��---.... 1 �'v . Date Application Disapproved for the following reasons:...................................................................... ....................................... ........................__....-•-----•---------•--------------•------------------------------------ Date PermitNo......................................................... Issued_ -----------------••-----------------•--- Date god 701 THE COMMONWEALTH OF MASSACHUSETTS BOAR® E HEALTH ....---...../OWI).......OF....... �� ,C.1.... ..................... ApplirFation for Disposal Works Tonstrur#ion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (/<) an Individual Sewage Disposal System at* ... .... ................................. .......... I - location-Address r Lot No. Installer � ddress Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other 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.........•-••------------------------- .. Test 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........................ a' e ------- ........... � .................-------------------------------•-•...--•--•......................................................... O Description of Soil........ .-_ !✓� ....'...._ t�Y .L% '-------------- x -------------- ----------------------------------------------•••.......... .. ---------------------------------------•--------------------------------------------•--------------- -------- W -----•••---------------------•-•----•------------------•-----------------•-------...--•••----••-••-•----•---. ......................................................... ............................... UNature of Repairs or Alterations—Answer when applicable...___.. _,1 fJI'1C / P/ / ••--------------•-....•---••------••..........-••-•--------•-------------------•---...........•-•••----••------------------•-----------------------••-.................._..------------•••-••-•--.•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITITE 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 ned...�� 1---Sn �--_. -•--------- �.��_....-•--- ` cX c J a� te vAPPlication Approved BY . :..: �4 V ' Date Application Disapproved for the following reasons::_____________________________ -----............................................ ---------------------------•-•------•----------------------.-.._..............-----------...-----•-----------------------------------------------•----------------------------------------•------------- Date PermitNo......................................................_.. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH ......�% � %..: :oF.. . '�.t; 1 ? `:................................ w,wrtifiratr of ToutpliFanrr THIS-.1S,T0rCERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X) by.... ', I'.... /iGi! f_� may' _'/ l'J,_1- � 1 - ---•-•--------------------•---------..........------- ................... -- at... . ......... .... --__--. .. ---- . ----......-•-------•-------------•------------------ .... has been installed in accordance'-With the provisions of T r of The State Sanitary Code as descr' ed irf the application for Disposal Works Construcfion,Permit No.. ..........�o.y_.____._____ dated_... .......................................... v THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION((SATISFACTORY. DATE.. �� f/`v Inspector `.�� ' ft.:-� , -r - r •.� -f a �,4r i.s '4�'' �' ,Y�•-, r+M *ia Y ""� .t•. 3,r7, ,,,,�t r'•s.1, ,�'c. ..��.:`"3�_�-i.'*if�.'..xi3�h�.miv^'�u uadwres'+.e-� :�r`:'.•1 THE COMMONWEALTH OF MASSACHUSETTS --- BOARD OF HEALTH �� 7 D /fJr' 1� .......OF , � ............................. _j� li!t1 N ........................ FEE ................ �rk� �on�#rttr$uan rratti� Permission is hereby granted__ : .:. �........i -...... ............................ -..r:...��-. to Construct (f ) or Repair (Y ) an Individual Sewage Disposal System atNo. - 1..............•----•--------..•---..-.----_--/ ---===-- --St-- --------------------------------------•--•-----=-•............. •............. / Street I as shown on the application for Disposal Works Construction Permit._.._...._ ./-'_. a d.__ ...................................../ l '� r O Board of Health DATE. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS `S