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Home My WebLink About0052 GOOSE POINT ROAD - Health (2)�- �.. i �� II ;L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHY ADPW i 9 .....To L✓/✓................ �.- Appliratiou for Mipasal Work.6 Tvnstr Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal s"C ,fit: a� fJDSr..P-klN -flc/L....................... .......�o-T-�........""' Location-Address or Lot No. S.._._............................... � --�--� -- �g.��....! !�.Q ............................... C,�....... .... as T h /� Owner Address W1. o.... ..... ............... M Installer Address Type of Building . Size Lot................ .. ..Sq. feet U Dwelling—No. of Bedrooms...........:................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons................ .......... Showers — a YP g -----•--......-•---......... p _. ( ) Cafeteria ( ) 04 Other. ............................ . W Design Flow..........tLt .......................gallons per person per day. Total daily flow.....3,35-............................g a�lIons. WSeptic Tank—Liquid capacity.lo�9.gallons Length.R..6....... Width:_�,�Io�'_. Diameter. �O___.._ Depth.:_.l..... x Disposal Trench—No..................... Width.................... Total Length............. Total,leaching area....................sq. ft. 3 Seepage Pit No.............. Diameter.......... '.... Depth below inlet....`f 3 r........ Total leaching area. sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed b .. �anPiS.�r�i.fc:.. .2 ..._r�i L* Date....._:-t:7_'7z_.... Y �.. Test Pit No. 1_. ....minutes per inch Depth of Test Pit...../?�.._...._ Depth to ground water.A�...4.7-0 44 Test Pit No. 2................minutes per inch Depth of Test Pit.....11......... Depth to ground water.Afo.....�f_y�Q x _ ------------------------------------------------=---- _ ---------------------- .............----••••....... -------- 0 Description of Soil...1_OE.SOtL....Q.'-3.....44'cl?.. !�y�..."!✓-.. ,�!?i4 v �_.... ................................................... ...................------------ ................................................................................•-••---••-•-----••---•- Uw ....................................................•-•-•--•--- .......................................................... 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.:I'L-- 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. ... ............... .. ..... Signed.. �..� ��..Z.... • . Date Application Approved BY----- ( .�� -•--.....----•-------------------------- .......�11 Date Application Disapproved for the following reasons:........................................................................................................_.._.. ----•---•--•-•_.----••---........-•----.....•---•.....-•-•-•.........................•••.....------........-------•------•-•---•...........•-----•-•---•----------..............-----..................� Date Permit No...... .1 - rJ��................ Issued_..................- ............................... Dattee No................ FF113. THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH L./ . .."V ................OF....R�MA�sTtl'3 Appliration for Uispaaal Works Tonotrudinfi/pewm' d Application is hereby made for a Permit to'Construct or Repair an Individual Sewage Disposal System at: goo5t�-- PDilvT M "1,OT /7 e Y11 ----------------- ............................................................... Location.Address �6 or It No. ................................ .... V e-4—A ....................... . ..... ............................. Owner Address ......................................................... ................................................................................................. Installer Address Type of Building INA Size Lot............................Sq. feet Dwelling—. No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ..............I.............. No. of persons.........._._............... Showers Cafeteria Otherfixtures ................................................................................................. ............................................. Design Flow._._....__tlto ................gallons. ............gallons per person per day. Total daily flow---. *�/N *.....** flons Length . ... I I.. I.` J-" I" Septic Tank—' Liquid'....c'a"p"a"'c*i't*y5q2.9.ga K� Width:. ... Diameter_�t'I� ...... Depth.._' Disposal Trench—No......................Width.._.........._....... Total Length.............-_._.._ Total leaching area....................sq. ft. Seepage Pit No.._....._..._....... Diain, r.......... Depth below inlet....'3/........ Total leaching area_:;Lt�.z.....sq. I t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.:n.m.!,!n....Ts-.�JIL! Date..1--t....7- '12- .. ......................... Test Pit No. ....minutes per inch Depth of Test'Pit.....L _;....." Depth to ground water.AID_......44 Test Pit No. 2.."-2......minutes per inch Depth of Test Pit.....12 ......... Depth to ground water.-An..... N .................................................................... 0 ..........1`t?'+1/vt . ...........................................**...... 12 Description of Soil... .................... ............../................................................................ ........................................................................................................................................................ -------------*........ ---------..........................I............................................................................................................................................................................. 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 T I A'LZ 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 Signed .n.. . . . . . ..................... ...9....Z .... .. ... .. ..... leel� Date Application Approved By........... ........... ..................... ....... Date Application Disapproved for the following reasons:...................................................................................:......................... ......................................................................................................................................................................................................... Date Permit No..........7.4-=....17;�Z Issued....................................................... Date -------------------- ----------------- ----------------------------------------- --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ :............OF.........1 1, ................................................. Tertifiratr of (911m, plitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V) or Repaired by............... !!........ ........................................................................................................................................... Install at..............n' -------- -rM -,-n�!- _......P-C�....jlg��.........................f-119-.10-17 ---------------------------------------- has been installed in accordance with the provisions of TITLE 5 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............... - '� - .LD------------------------------------------------ 'T.......tz------------------------ - --------- -------- ------------ ---------- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0.7 .............XZV.e�4A............OF.......... .................................... N . . .... FEs.... ......... aispowd Works Tonsixu butt'rrmit Permission is hereby granted ........................................................................................... to Construct (>-) or Repai-r an Individual Sewage Disposal System at No. ......./...'.7....... ...... ...............t!nr.... .. ......................................................... Street as shown on the application for Disposal Works tion Permit No. �.S_, Dated-.-"7.................................. ......... ............... ....... Board 0-i DATE ! L Ft s, f li,^,i E DATA NGi res 0-A, ;SErr l7, i 4l1 1. p "J/AC NYAAINj5 0,.IA 0. � ` `" � �01 IV ttNv+NEC R: �/lMtS L. T07I4E �. /YI!Ni�.QdM F�IF"� l:+''t'Gh1 s ,�• (z00':-, � /^-^ � �.� sa.-p4 Al' -��s1 T� .^.mot C.r1.Q14f1ft 6 {t_i.r,kf j 3. De5!6v coA'o)A'G i)!� AEI- F1z�CASr- 1 '' } �tFilaFR: TnnN A1r0 ✓NETS ro Qc it 0, t .} ~''GCL r2`► G• R'I�f6 =G Ml•r"✓/ JAGH ;f . 1'l ' TdtYfS ro 13E' A4ALitr ��IIIte�i� �^ + } 5. 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