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Home My WebLink About0017 GOFF TERRACE - Health 17 Goff Terrace Centerville A= 171 - 102 0-9.1fUPC ssLO 0 •'.. 1V�.L__. _Y. j�//).. / FEz....44...............«. THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® QF H�E&LTH a --- . ..............OF...... --- --- -.....-------------------------------- Applira#ion for Uhipaaal Workii Tomitrurttnn FrrAtit , Application is hereby made for a Pelmjt to Cyst- �krg, r (� ) an Individual Sewage Disposal System at: ��/� % ( j �, .. ,. ._......._ ... .... ................ `--- _.. .-�-�'-----........>.. ............ ion-,A r s or I of No ( � _ er - d ss � w .. f =-- Installer Address (� U Type of Buildi Size Lot____2_-7�j ...Sq. feet Dwelling—No. of Bedrooms................................._..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixt s d ---------------------------------- ------------------------------------ - W Design Flow__________ ___ �_�.______________gallons per person per day. Total daily flow.___._ ____.____.____.___._____gallons. WSeptic Tank—Liquid capacity itOVIC>gallons Length.,8........... Width_.S ......... Diameter________________ Depth... ______-. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.......J........... Diameter..... __---------- Depth below inlet....A............ Total leaching area___l_®D.._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by_________________________________________________________________________ Date....................... -_-- ----. aTest Pit No. 1.. .z-_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........................ .........................................................- ................................................__....__........_...- 0 Description of Soil.......® �.a- -------.40.- 'a....--•1 L- �•. -•3 �� 5� `�' ......� .4 U W ••--------------------------------- UNature 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ,operation until a Certificate of Compliance h been issued by the board of health. gned................................................................................ •-•--•••- Application Approved By. --• ----------------------------------------------------------------- � Date Application Disapprove or a following reasons:-------•------------------------------------------•------------------------------------------------.._........._ ................................... ... ..................... ••••--•-•--•-•-•••-•-•._....•--••••-•••-•--•••••••••--•••••-•-•••-••••------------••-••-•••••__.......- ......---------- Date PermitNo......................................................... Issued_....................................................... Date No................_....... FEE... 0, „....... ...;.. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HgALTH OF. Zr Appliration for Uispoii al Workii Tonatrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• ? .--•••...•--..._. - • -- •-•---•-•............................. .. ......................................................... g.... o. -t1 s ! t ,JS or Lot o er InstallerAddress UU Type of Buildi Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 14 Other—T e of Building No. of persons............................ Showers Cafeteria a' Other t. ga ------------ Design Flow___________ ____� - ----_------- llons per er day. Total BailY flow_.__._.___............................................ gallons. -- —Liquid caP __j -------•------- Depth----Fy--1:4 Septic Tank �f-d2 allons Len th ____________ Width 5' _._._... Diameter. ! Disposal Trench—No_____________________ Width. Total Length..........`........ Total leaching area------- _ ----sq. ft. Seepage Pit No._____._.I.......... Diameter____________________ Depth below inlet_____"___________ Total leaching area____'�_��___sq. ft. Z Other Distribution box ( ) Dosing tank-( ) a Percolation Test Results Performed by............................................... __ _�/ Date....................... _1. c � Test Pit No. l----------- minutes per inch Depth of Test Pit............ Depth to ground water........................ (s, Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ O ---�•••---•-•;.----...•--••••.......................... �. Description of Soil........ '- 'g.A� e� 'mot? 7 �'f. C.Q.;O.S--��--............................� .------------------'0/'4-"` `' d _ 'et ''a_'fir•w 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to-,place the system in operation until a Certificate of Compliance ha een issued by the board of health. a� W. 1.�' ned--•••••••••---••-••-••................................................................ to ..._••--•••- APPlicationApproved BY " --------------•......................................................... ,.�R .... Date Application Disapproved r e following reasons---------------------•---------•-----•--•-------------------------==-----•---•-----------------------.....__..._ ........................................... ......_-----............................................................................................................... Date Permit No....................... Issued.......................................................Datie E THE COMMONWEALTW-OF MASSACHUSETTS BOARD OF HEALTH, . ........................OF.................................... 3. .............. .....:................._:......................... s THia C IFY; That the Individual S wage Disposal SZstn constructed ( or HRepared ( ) by...---------- °. .��'....... ----- - ------------------- .....................�f -- �} Installer /A .. y� A, ..•• at..... •-••• _._._...--•••_••••• /iN - ..._.-•- -----•---•------------- ------------------- --- _ ----•------------ has been insalled n accordance with the provIT z5 oV tate Sanitary d ed m the application for Disposal Works Construction,. ___ ." .�+.-._ .____. dated .._.___. -_ ._..- •--__--- -•••-•••- THE ISSUANCE OF THIS CERTI CL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFA RY. � DATE................................................................................ Inspector......................................-............................................ E THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH :.................................OF............................................................................_..:......... I No - ............7 FEE........................ r anitrnrtion "permit r. Permission is he gr ......�- ---------- -' ---- •----....._.. _.__..... to Construct ( or air ) a� Indio e D osal stem at No: a' ... ............................ treet as shown on the ap cati for Disposal Works Constction Per o ________________ Dated........-........................... :.._., DATE.:_. „/ --- ................... •--•------• = } a of Health Boar tk »... r ..... g . FORM4255 HOBBS &r WARREN I�NC PUBLISHERS - a ../- TOWN OF BARNSTABLE LOCATION no �,^��" � ��° SEWAGE#9341 VILLAGE !1 t' ASSESSOR'S MAP&PARCEL O� INSTALLERS NAME&PHONE NO. �(/Ilr Aj��] SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS -� n i OWNER i Ck /7 f �!9 ✓1 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r LoT , 2 �i7tN AMD N , i ;I �j11JG�L- FAMILY( - '� BEOR�oM , •`�4. I. a GA(15A.GE 6QjwDEcz pA%Ls( FI-oW a 110 x 3x 330G.PP JI SEPTIC TAQK = 330x15o% : ,495'6.P. I U E loon GAL. i 015Po5AL PI•T v4E 1000 GAL. 5%DCWALL AR6la �I BOTTOM AREA+ , T., •ToTA I- DESIGN = ,g-2 5 G.R D. 3 Q .. .. ' .�' E'w'�, 743-TAB.. pA 11-Y FL Oyf = 33o G,PO, N O,�a.�, '�•-3 ! ►v `�'� j P62COLATION RATES 1''IN ZA N ol`LE55 7 ' of 0 qua 99 z 3 99.c, I P4CHAfiD JOWES BAxT� ti 25 I. fia 24M G�� 7E,42,2A CL 1 s ' /• zaoje ToP FNRIgi'•.o Hsi71-z z/,a3 ; ge, Z I .Sv,�SoiL PIST. INS C,A6. 4 ) 1 G .I Z PRO PIT INY 6�yc 97B " TANK ,.� �t �cAcu 97z PIT INV. INY. �JED. W I T W 97 1/ P7G i S.4.vZ;l WASUGD I{ I 6T0N6 9/ z CERTIFIsD PLcT PL-A-W ' ova c�/arr'2 PROF I L G- B7•z LoCA� IoN GENTE��/�•1-� No SGP.L1E o J l SCALE /'-�0., .. �P'T'�!• N � IP E A 1�1 RE F ESE• E IS ► • CERTIFY ?NAT TH�� F�.5No11�(N ►{EQEOIJ GOMPL`(5 1�IITN"SHE S l D6LIN E �OT � . AWP Ss:iT5AagR.6QUIR.EMENT� oF 'CNE- 'TOWN OFF AND IS NoT' 6/C 27s ��• �� L0C, .T D IT W E G1..OGD PLAIN DAT Cl c BAxTE�t NYE INS• ' RED I S��c��►v ►.AN D s�ev�Y�es 'Tins PL&W ►5 WC)rT 5A\5c n O►d A MASS. 1W5T2UM6NT dsv9-V Y O'THE OhF5F-71 6uouo Ll ram ��cn-rn MF•TPQMI►.da oT �I�F� APPLIG.0, Tor pESIGtJ A. 51►JGLC- FAMtL"( •• ":� BEORooM ° } }JO GA2BAGE C�c2.►n1D62 I _ •• <,�+• ' PALLY F%.Ow z Ito A 3 SEPTIC TA►• w_ = 330x15c>% ",4956.P. q u51= 1 000 GAL. j I /30/ o15PO-4AL P►'r- v4E lOoo GAL. 5 t PS WALL AeGA - 1 51lo 6.F 37 =r.it. BOTTOM AREAS �S.T L o S.F x 1 0 5 o G.P o 5 70TA�_ Drb.SIGN = ,-25 6.PD. 3 Q G ,.- . 7 Q :.;� •`� 'TOTAL DA 11..`{ FLOC.( = 330 G.Po. � O,P�.� 993 PE2GOLATION RATE { I''IN 2MIN owl-ESS I �7' Of I ALAN FACHAfiO ,ow,s BAXTER No.24048 o � R I i TIr' P- zzo� G sla4 TOP FNR=Iq % "4 "7 loon I su�SoiL. DIST. Q INJ. Dux 978 SFPTIC, 46.0 ,► ' ,: (000 INS TANK j �GAGN . PIT INV. i.Ny. 13 ,yEa. W I T u 97 �i S�.�D 1�3/9•I�L ' WAsur.D 4 I I 670µG /L GESZTIFIG[) pi-oT P1._AW• Ho o 1,471e'2 B7•z 1.o C A-T ►o N GENTE��/L..L�- �. NO. 5GA.LL- SCALE /''=c�p • �ATi'c� . �• FY TH AT -T Nr� � F�.5 Noww PLAN REFE2ENGE• CE9XT► , E{6.REOW GOAPI.` !S YJITN"THE S 1 DEL%W 1C �T Z AVJD SET�G R.6Q ►R.EMEN7� oF -t1AG- '(o W N O F.�l► ' TO.� A N U I S I�IoT 2 LOC-PT D • IT 1J E G1 000 PL IN.IN DAT BAxTGV_. WYL- 1NC• ' • j R.E61'.S'T EQ6U'LAIJ D S u f�Y�YoeS TW!5 PL& J 15 NOrT Ord A W 03TE2.VILL�• ' A4065. 1)45T?_UMENT 5veve`( 4-TNE Df=F5ET� .6 c wc ty . Uft- nc a c r , isnTh n�V= UH,I►.1C o► •r L_1QG ." t'' A PIP LICA1l-IT3�176�TL:�S