The URL can be used to link to this page

Home My WebLink About0076 GOOSE POINT ROAD - Health X SMEA KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Cer ified Flu Sourcke pOST,CONSUMER mvw.5ripmumm,arp 00 SFFOIi90 MADE W USA CST OIRG1NIl.ED AT SMcAD.M g � TOWN OIL BARI�I`>TAELT: L(VCATION.l( _.��Se �" �?, SEWAGE #U 7 VILLAGE Ce ,rJ ° 1( S T, L- p t15SLSSC)TI .: ZdL3T? �x Lf77��0� IPISTALI EIt'S NAME PHONE NO.C _r� �__.. I_L'a� J.... Sk'pnc TANK CAPACITY__;_ LEAC HING FACILITY:(type �"�-��`` �+� _ _�si�e) l@+_�a� ,NO. Of BEDROOMS 3 - -PRIVATE �'ELL OR PUI;[.I(: _A=��Ii�_��_ bUILbE,111 OR OWNER b DATE PERMIT ISSUED: 's DATE COMPLIANCE ISSUED__ VARIANCE GRANTED: A, t 3� ° s i VOL loot c.P. '35° '�Co �� (�o►� �- I��, Cep 4-- �� 1 r THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL + Tb.-. ...... ......... ApplirFation for Iligpnaal Works Tonstrn.r#iun ramit Application is hereby made for ermit to Construct ( ) or Repair ( ) anC Individual Sewage Disposal System at: o...................I.......................... V 17?LocatioK.., ldr No ss � ) �v t . W O � �, -- ...�_G.•......a........��_.._ wner _ ..............................•-..•-----... Installer Address Type of Building Size Lot............................Sq. feet a ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a . 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •------• ---- ------ ---------------------•- ................................. 0 Description of Soil....... ._ -...._ U ••-••-••-------••--•------•---•-•-••................. •-------•••- -------••-••-----•--•--•-•------------------------------------•------••-••••--••--••-- -------------------- ------------------------------------------------------------------------------ -------------------------- l •-- U Nature of Repairs or Alterations CA�nswer hen a abl _ _" �_).______..... �:c�°__ _...._.. .. --.............................................1-.••-----•------•----•-••. !--�••-•-•-•-----------------•-----•-•-••-----------•-------.........-•--•.....-•-------......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitar Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h be iss by t oard health. Signe •... . --• ------------- - .......... l 1 Date Application Approved By............. 2 ..... __a.. Date Application Disapproved for the following reasons:.................................................................................................................. •-•-••-•-•----•-••-•-•---•--•---••.............................................................................................. -------•-------------------------- - ....................... ....... V Date Permit No........ _. . 2 (o P O g ��:....� ......-•--•-------------- Issued.--•------------•-- •-----------...----- Date THE COMMONWEALTH OF MASSACHUSETTS BOA R Dr-GF HEAL H .:.........'.... ..---.....OF............ S ................................... Appliration for Disposal Works Tumitrurtion 1hrmit Application is hereby made for a Rermit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• y �....J �. �.. �_� ° `. ...........�.. ................................Q �.. LCoc�atiodrgss Lod No. ..... —. G � v ��;....c -----....•( = .. .:. 6!2 r.._ e�..:�v .........� 2 .---..... ..C.......` t._. ..._...' .°......V `_c s . Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___._"'...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' rr . ...--------•----•---••--•----•-•---...----•---•-•-----•-------•-------•..............'•---------•-•----....._'-------.._.......---- D Description of Soil......._'� yPs_"`-.___ - U ----------------------------••......---...... -•------------- --.._..--------•--•--••--.....-------•-••---•--------------•----•--•-----••-••---•-----•-••••--•--------•---•-------------_. xW •---••---------- ----------------------------------------------------------------------------------•------------------------------------- r -------- ------- U Nature of Repairs or Alterations—Answer when a b ,..______. ..................-: .__.......__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LEE 5 of the State SanitarYY��Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h be$n issued by th`,board "f health. q V �!J ! SigneGt'....... -----1................................................... Date Application Approved BY--•••-••-•---__ 7-.-_--------t;,t.....................................`..`...,.-- -----------•-----•--•--- ---•-------•-----•••- ------------------ Date Application Disapproved for the following reasons:............................................................................................................... ------•--------------•------------------------------••------------------......---------••-•'------••----'--••-••-•--••--------•------------------•---•-•-••---------------•••------------••----••-_----- b � Date Permit No.......... . ..:..t.. - Issued / .............................................Zda Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..........................................OF................................................................................. uprrtifirate of Tampliaurr IS T�CkRTIFY, That the ndividu 1 Sewage isposal System constructed ( ) or Repaired by....V!T(A —N ";-q Installer at------------------ ` p ~ `` - has been installed in accordance with the provisions of 11'171111`�21 j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---------- /-._'.____. -__._. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A'GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-----•-•---•--.._..._............._-----.......------•---.._._. Inspector----------- ---------------------------••--------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH 6 'r 1, '`7.``'.` `.................OF..... ?..:-.•^-:.'� a.ao No....... FEE........................ Uftivvj g ,� ; Permission is herebyranted.................:. _._..._....... - __�_...__._ ^______`'-__....................................................... to Construct ( ) r Rep it an Indiv}.t.1 SeH=age Disposal.-System atNo.•----------- �._._...1 a'.............................. : � ...._...---•-•--�G" ----------•-----------------------------------------------------'-- Street 2 j J 0/ (� as shown on the application for Disposal Works Construction Permit No_____ ______________ ated.�_�...__....._..._:._._ ......... 7�. Board of Health DATE------- -----------="----...._..--------•--•-•................................- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS