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HomeMy WebLinkAbout0107 GOFF TERRACE - Health (2) �0� God{ Te r�c�ce, CQ.� f F No......... -T t q Fxs.,e ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �-�VP, I., N..-.-......OF.......Y. (i Application is hereby made for a Permit to Construct (V� or Repair ( ) an Individual Sewage Disposal �ystqn at: C U st__ l o ....- T ....--- Rj ocatton- d s �. gr.Iw q �/ /` /t/ ... -i ' ...-_: ------ ... ..........•._.. %J-- ....I......................................... Owne ddre a ••-••-•-- ----------------------------------- ----------------- •�°� '�-----------•---...-----------.. Installer Address Type of Building Size Lot./V.&Q-------Sq. feet Dwelling—No. of Bedrooms..............------------------------------Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... Design Flow..................5, ..................gallons per person en day. Total dai1X flow......... _ __..______.____._.. dons. WSeptic Tank—Liquid capacityl�gallons Length... PO`Width---!_�Qlbiameter--.4_16."Depth__S x Disposal Trench—Noj____________________ Width------------------_ Total Length.................... Total leaching area....................sq. ft. .� ..........Depth below inlet .......... Total leaching area._....___ Seepage Pit No--------/.._______ Diameter------- p g ,�- .._sq. ft. Z Other Distribution box (vj Dosing tank ( ) Percolation Test Results Performed by.---------- �_!�...5 :%_l�G. . _ _ Date._C� %-... � gv r - aa Test Pit No. 1.G.2,.minutes per inch Depth of Test Pit....1.2---------- Depth to ground water_._.... f? Test Pit No. 2.._=------------minutes per inch Depth of Test Pit.................... Depth to ground water •-.___ •---•------------------------------•----••-----••--•----•-------------------._...--••--•-----------.......................................................... O Description of Soil-----. , 2L------------------------------ � --••••-••••-••-•--•---•--••-•---•----- N _ ----------•------- UWx --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------............. V Nature of Repairs or Alterations—Answer when applicable..............................................................................................__. •----------------------------------••---------------------•----------------------------•----------•---•--•-•--••---------------------•••--•--•---•-------•--••...---•--------••-••-•-••-......••---.•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rovisions of Ii p 5 of the State Sanitary ode— The ndersiQ d further agrees not to place e system in operation until a Certificate of Compliance has b en i ued b th boa. of health. Sig -- •-- -•--•---•--•. .• --.............................. --•- ....... ................ Da� Application Approved By..........T� ��G�? �17- -•' Date Application Disapproved for the following reasons: ----------------------------------------------------------------------------------------- .................................................-...................................................................................................................-.................. ......... Date PermitNo......................................................... Issued....................................................... Date 4 No...._..... r. FRs. ................. THE COMMONWEALTH OF MASSACHUSETTS : t BOARD OF HEALTH a ...................... ....................OF....... ............... F Appliration for Diipniial Works Tomitrnrtinn Vamit� Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal rf System at: ..--•--••---....----- -lit 4 .�°c "l C. ..... ............. ocatto..- ddr sLot OI dre.............k. .......•............="....... �1- lf4 x'J ----------- ----------------- P Installer Address U Type of Building Size Lot_ZSZ _....Sq. feet a Dwelling—No. of Bedrooms.._.. --__--Expansion Attic ( ) Garbage Grinder � Other`—Type of Building ............................ No of persons_............. ...._..�. Showers ( ) — Cafeteria ( ) 04 y Other fixtures ----- ------•-••-•---------------------•-•--•----- -•--- =--- ti Design Flow.................!.�...............••__gallons per person er day. Total daily flow .... ......_.........gallons. WSeptic Tank—Liquid capacity/O&Agallons Length-__ ' '(Width.. .4..ZC3�ijiameter._.' _� !4llepth. " Disposal Trench7—No .................... Width.................... Total Length.................... Total leaching area....................sq. ft. ' Seepage Pit No-------I.._....._... Diameter....... --------- Depth below inlet...6............ Total leaching area.. 2---sq. ft. Z Other Distribution box (V) Dosing tank ( ) ~� Percolation Test Results Performed by------- +.� - a! ?.'.' .. ......... Test Pit No. 1__4.._1-.-minutes per inch Depth of Test P,it-__-1.` ."_._... Depth to ground waterAj,'� 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water2 w--eltr I. .,Srt SID D Description of Soil...... �f+�-,-�; ..914-� (:-sk -------------......----------.-----... ------------------.----------------•---------- 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'TT LE 5 of the State Sanitary ode— The ndersi d further agrees not to place a system in operation until a Certificate of Compliance has ben ued b t boat of health. Sig --•-- ....-•---- ........... - --- --- ............................. ...-........ ................ 1) gg ae Application Approved By -------------------•- I--- - �' .. Date Application Disapproved for the following reasons-.............................................................................................................. Date PermitNo......................................................... Issued..................------------------•--•---•-•--•-•-•- 3 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trr ifiratr of f ompliFanrr THIS IS TO CERTIFY, That the)nj.viduj4 Sewage Disposal System constructed ( or Repaired ( ) by-------------------------------- ------------------------ .4-�-1 . ..... - - staller at has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction PermitNo----------------------------------------- dated-.... / .............. THE ISSUANCE OF THIS CERTIF1cATE'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... �f�/� Inspector....---1„ ------------------------------- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD/OF HEALTH '`�?` .........OF..'.r'' r -,1 ...................... 30 ,--- No.......... ......... FEE...--------........-•--- w ;. Disp> m nrkii ( 1BArAdion prrutit Permissionis eby anted--•--• .,.. - ----- .!t•. -----------------------------------------•----------...-••---••----.......... to Construct` o R ( an Individual Sew D�is�po System a Street p as shown on the application for Disposal Works Construction r it No.__ Dated.._.._/_--.-_/.7.'"�/w.:..... t �. - oard MAW:aith44�- --------------------- DATE............................................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �Y.'?S:N rv'J r.,'ro J.Y"F t�... 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