HomeMy WebLinkAbout0024 GOFF TERRACE - Health (2) /�� �/off
F.Ru,d.....................
THE COMMONWEALTH OF MASSACHUSETTS
n i
BOAR PF HEALTH
cv .. ...........OF............fL./ N�1` �._�9 .................
Appliration -fur Di iVosal Workii Tate trttrtion Punift
Application is hereby made for a Permit to Construct (V/ ,Or Repair ( ) an Individual Sewage Disposal
System at: _
F...f ln- ' F? ........ o/-a--------
tion-Address Lot No.
Ica -•-•-f--
6� = ` t�r,�' `- ---------------------------- -ll...../U�L t........ �,rt.1 --..--l.Wt1 .......Vj/
Dp Owner / Address
J
w S C. . ----- L L
Installer Address
UType of Building Size Lot----------------------------Sq. feet
�+ Dwelling—No. of Bedrooms----------�.........................Expansion Attic ( ) Garbage Grinder ( )
per.., Other—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria ( )
a' Other fixtures -------------------------- -
w Design Flow----------- ........................gallons per person per day. Total daily flow--------;?h(20.......................gallons.
Septic Tank—Liquid capacity./eW_-gallons Length________________ Width................ Diameter---------------- Depth.__-____-._....-
xDisposal Trench—No- ____________________ Width.................... Total Length.................... Total leaching area-------.------------sq. ft.
3 Seepage Pit No------�------ Diameter-------------------- Depth below inlet..................... Total leaching area--__--------_----sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY---------- -------- ...................................................... Date------------------------------------
14 Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit.................... Depth to ground water--._-__-.----.-.._-
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------------------------------------------------------------------------------------------------
----•----------------•-----•-•---•-•-------------------..
O Description of Soil- =`-•-------------•---------------•-----•---------------------------•-------------•----------------.-
x
U ....................................--.............................................................................................................................................................
w
VNature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
---------------.----••------ ------------------••-•-•----------••----------------•--•--------•=------••-•---•---------•------••----------•-------•-••-------------------•---------•---•----.-----------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage -_•sposal System in accordance with
the provisions of Article XI of the State Sanita Co — The upder 'gne u the agrees n t to place the system in
operation until a Certificate of Compliance has ee ss ed by the d f
Signed_ r.----- ...... ,"�--•-
ate _�
Application Approved BY f F --------------------- `-��--�-`-------------
Date
Application Disapproved for the following reasons: ' ••----------------------------•-•-•-----•---••-•-----------------•-•-----------
•------------•------•-----•-----•--------------------•-------------•-----•----•-•-------------------•----------------•-••-•-------•-----------• ----------------.---------•--•-•--------•---------.-----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O/F HEALT-
' - . .. ..- ......... ................
uIrrtifirate of 0,11mpfiaurr
THI IS T0'CE 4`IFY That t►e Individual Sewage Disposal System constructed ( or Repaired ( )
r ... _
by ....1 = ''= -----=_-- %---------- -- r
�i Installer �"1 , r
:r � fi
f s" �10
at_...... " `'� f y 1 1--1. f i ...---�i�^r--••------- �3r �-C.a_.r
t
y _ _. _ �__. _ Y __._____ __ __.4 ._ ......................................................
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N6_1_t' b_:___-e _. � ---------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALE, NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................•'.....................................--------------------•-----
.......................................................................................-..•........'•...•a...•...........•...............
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF,, HEALTH
r 3 1 .
.OF ._......
No ` ,, ...............................
FEE ...............
�i��u�tti urk,� �uu�tr�trtiu$t fir-rntit
Permissionis hereby granted.......................•--•-----------•--------....._..--•---------•---------• --------••----------•-------•-....._......-----•--••--.......
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No.
Street
as shown on the application for Disposal Works Construction Permit No-- ------------------ Dated..........................................
..........._...c. ------
Iio Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I
�
THE coMMowvysALrH or mASsAo*usErrs
BOARD OF HEALTH
OF- ��» /. P ,4=-��________
App �x����_~° ��� ���� °�
��*+��wwv� � xowo� Workii Toumot4urxoon Vao4ift
Application is hereby made for a Permit to Construct (V.�or Repair ( ) an Individual 6r`°agc Disposal
System at:
.................. -'-- ....................... ...........................*V_-2 � ___
'mation-Address or Lot No. LI/
----- ---_----- ..' ---�+���£��^//'�//
Owner, Address
.-__'����'��.--��.����u�'�--------.--'.-.-----.- --_--�.'/.. .�---'--_- ................
Installer Address- Type o[ Building Size Lot--.---.---..Sq. feet
Dwelling—No. of Bedrooms---------^12-~--------'-..Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. ofyosons--------.- 3bmvcrs Cafeteria ( )
~� (}t6cr 6`tucco -------------------------------------------------------''---------_---------------------
Dcuigo Flow..........���_--------gallons per person per day. Total daily flow--z>2.<y��-------.-gallons.
5cy6c Tank--Liquid Length................ Width----- Diameter----.- Depth------
Disyoxa Trench--No .................... Width.................... Total Length-----_. Total leaching area--------------------sq. 6.
Seepage Pit No k-` ------- Diameter------.. Depth below inlet.................... Total leaching area------- ..........sq. b.
Other Distribution box ( ) Dosing tank ( )
~~ Percolation Test Results Performed by-.-------.-------.--'---.----'' Date.............---------
Tev Pit No. L-_--_minutes per inch Depth of Test Pit-------------------- Depth to ground water --------
cZ4 Test Pit No per inch Depth of Test Pit.................... Depth to ground wotcr'--'-----
0 ----------'------'--'-------'-'----'------'----------------
Descriptionof 5oi.=-------- -------------------------------------------------------------------------------------------------------------------------------------------
----------_------------------' ------------------------------------..'...................._.......'.............._............'......................_.............................'..................
�� '-''--''—'----_—_''------�----_-_'--------.-_---.-'---_--_-'--------.---
U Nature of Repairs or Alterations—Answer when applicable------- ------------------------------------------------- --------'
-----'''-'----'-'—'-------'----'------'----------------------------'---
^^grrcmeoz:
The undersigned agrees to install the uforcdrxcribed Individual Sewage
the provisions of Article XI of the State Sani - Co e—The underpg e f the'r agrees not to place the system in
operation until a Certificate of Compliance ha ee issued by the/c rd h
ate
ApplicationApproved uy.��� .-��-������x������ ���',r_a---� '
Date
Application Disapproved for the following reasons:. ......................................................................................
-'—'---'''----'-'--'------'—'-'---------------------'--'----'-----'-------'--'-
u"te
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH ormAssxoHussrre
BOARD OF�HEALT
TH�S, is F CE�5117Y, Tha Individual Sewage Disposal System constructed (4��'o, 'Repaired
---------------------------------------
Installer
has been installed in accordance with the provisions of Article XAo�The State Sanitary Code as described in the
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ;9STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DAT�-_._._-_.------__---_________ ._____________________
. -
THE COMMONWEALTH ormxssxcHussrrs
BOARD OF HEALTH
OF--'�-.�' --------------'
--� ..............
Permissionis hereby granted--------------------------------------------------------------------------- .................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo...............................................................................................................................................................................................
' Street
as shown oothe application for Disposal Works Construction Permit
--'-'---'-_-r'`~-'-��--- ----'---'-------
Health-
DA2�I-.__-------------.--'--.----_-. �
runw /255 xod'SS a w^nnsw. INC.. pvoL/y*sns
�
-.o r._,22
I
1z737 l
p .L oT z/ f
iS 14 7 �' ++
� —S9' a4• a �
� a
;Elo CUm—j)A r i oAJ ,
�. ONLY l
t
�2 T I q p F_�.L F C-.TR
E.�I:S.E Nt.EnJT
Scale 111 4014 1
BUILDING LOCaTigN rLAN
Being Lot # 21 as shown on
I a plan entitled subdivision
E f plan of section 2 Lumbert
! Mills in Centerville,
` Barastable Mass. by Newell
B. Snow, R.L.S. , Buzzards
cry Bay, Mass. , dated Feb. 9th,
1973 and recorded Barnstable
Registry of deeds in book
Thomas A. N ;
f .)ncASON 275 Page 55• �.
No.8937
/STO' �/ Oct. 1st, 1975
9:
C Builder: !
i✓ Yarmouth Port Homes ;
11 Uncle Jimmy Lane
Yarmouth Mass.
,i
TOWN OF BARNSTABLE
�g
OFFICE OF
BA3N9Ta. BOAR® OF HEALTH
H
y nA83. �
v� s539. ®®
By AY 397 MAIN STREET
HYANNIS, MASS. 02601
To : Building Ins,ector
From: Health Department
Subject: Test hole and Pe_colation Test
A examination of the soil at
(Lot) (Iddress ) ( 'Village) -
was made on 2 3 `7 S and found to be
(date)
suitable for sub-surf-ice >a ce se• ge,, at site of test hole.
Building Per it will not be approk ed or sewage perr^.it,
issued until Health Depa--timent receives two copies of plan
showing building, sewage systems and all other details listed
in Board of Health instructions to se-wage applicants.
This abnroval doer not constitute a final decision
concerning the installation of a senaage system.
. 11 State �?nd loca 1 �Iealth regulations apply to final
approval
(signature)
6/20/75
1
CA
4 !
q ,L 07 21
o �
24•PV q #4
�Ct�t�'tAl"1 oat ,
O izr.
Scale 1" - 40t i
_ BUliOlNG LOCATigN rLAN
44 Being Lot # 21 as shown on
a plan entitled subdivision
f plan of section 2 Lumbert
Mills in Centerville, i
t Barnstable Mass. by Newell.
j -B. Snow, R.L.S. , Buzzards
Bay, Mass. , dated Feb. 9th,
�. 1973 and recorded Barnstable;
Registry of deeds in book i
Thomas A. N . 2?5 page 55.
0 1ACXSON
U ~
# No.8§37 n i
i Oct. 1st, 1975
��9�AFC/ST ERE"GOQ,
uUK40 .
Builder:
Yarmouth Port Homes f
I 11 Uncle Jimmy Lane
Yarmouth, Mass.
i f