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HomeMy WebLinkAbout0047 GALLEON WAY - Health C-0-l I-e©n 0- PJ5`�- �07 7 LOCAT ON SEWAGE P 263I VILLAGE INSTALL R'S NAME ADDRESS I 6UILOE8 OR OVDER DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED qJ- 3 3 f o 3 W#Y � 1 0. No...... i..':.,��.3� Fss. ..-.........,.. THE-COMMONWEALTH OF MASSACHUSETTS BOARD A ®OF HEALTH .✓.......................OF...1�.1;716215.% ............................................ Applira#inn for Uiipnnttl 19ork.5 Tnnitxnrtinn rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. _... ._.1. ._.....�� ...'a ------......•... - / i3 s ro,�s..----- . Lls ................................................... Location-Address q or Lot No. `�'�/✓iY/5 S /o/..!t/ST/�C/CridA ol'� �—to (2ymer 0, Address a ............ . �. ................................... Installer Address Q Type of Building Size Lot... ...Sq. feet Dwelling—No. of Bedroom ..._.....:........................•.__.....Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Buildin 'K lee No. of persons Showers YP g ------=-•----."r-- ----- P -----------•------- ( ) •- Cafeteria ( ) Q Other fixtures - --...-•-•- W Design Flow........... �.........................gallons per person per flay. Total daily flow........_. ..........._.._._._..gallons. WSeptic Tank—Liquid capacity.faOd..gallons LengthA.•-•--__--_• Width._.. ._...._. Diameter---------------- Depth__ ....S._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....��Z------sq. ft. Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area............------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `/ '" Percolation Test Results Performed b � ,k__.._.. ross7�.✓__.. _._ Date.__�-3/. ................ Y ----- - -- - - Test Pit No. 1.aZ._........minutes per inch Depth of Test Pit--- _�._-_-• Depth to groun water.._.yQ!'': fZq Test Pit No. 2................minutes per inch Depth of Test Pit.............._..... Depth to ground water........................ P4 ------------------------------------------ O Description of Soil...�u ._..Sp-� -----------------� _1;P x U 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 L I'iZ 5 of the State Sanitary Code - The undersigned further agrees not to place th system in operation until a Certificate of Compliance has been sued by t b and of ealth. Sign_ �r Zo �/ Date Application Approved BY r�l ----1.....��� -•----------. Date Application Disapproved for the following reasons-----------------------••----•-------•-------•----------•----------------------------••-•------••-----•----•---•- ......................................--•••-•-••---•••----•-----••-- ------------------ Date PermitNo......................................................... Issued_....................................................... Date l � No.---. :-l_. Fps 30:._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..� •A✓,✓........................OF... !..fir /�%:,�� --P.. Appliration for Elispniitt1 Works Ton rnr#ion thrmit Application is hereby made for a Permit to Construct (,(/) or Repair ( ) an Individual Sewage Disposal System at: / ,rr .....7.. ...--•-------- _ ............... Location-Address or Lot No. •"!r✓i✓r< < ...............................................� / ............................ Owner f Address ..••. O(/ Installer � Address U Type of Building Size Lot... ' _.Sq. feet Dwelling—No. of Bedrooms.......... -.............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin / No. of persons Showers — a YP g"��=--���-•-J`./---• P ( ) Cafeteria ( ) Otherfixtures --------------- -------•-------------------------•--------------•---•------------------------------------.--.-----------•--- --------•---•---_----- W Design Flow........... ........................gallons per person per,day. Total daily flow......... _ .....................gallons. WSeptic Tank—Liquid'capacityl?.5�'v..gallons Length............ Width....�4......... Diameter................ Depth....... _ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-..f Z......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....N �....... ..................................... Date... ? _/............... Test Pit No. Le-2..........minutes per inch Depth of Test Pit__Z.F ... ...... Depth to ground water....N�'`' _.. 01, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------ ----•----..--------------- ---------------------- --•------ •--------- •----------- •......... ---------- O Description of Soil....-u / r/u.=r. = "=` "� W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TITL E f•1-••-� the provisions of TI Lc�, 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the b and of health. �� _, ' Sign d! ' .�.t.... . r 10, 'Date Application Approved By....»:� 4,.•�,2_. �! . r- ,+ -,' l= , ------••--•--- .• Date Application Disapproved for the following reasons:_.__.................................................... .---.......... ....•-•-•---•-•---._...-•-•-••--•--•--•----••-••......-••--•-----•-•-••--------------•••.....•-•-......•.-•••-••--...._..--•--------------•-----•-•---•---------•-•-•-••-•----••-----••---••-••--••-•--. Date PermitNo.............................. .................»» Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J '�V- ..................O F................... ................................P........................... (9rdifirate of Tout lianrr THIS IS TO CER .IFY,/That t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by i U 7 �� ��! Y iv ✓ � Installer 4 at-----------..................................................... ........................ ........-------------'•-............._---------------------......---...------------...._..------------ has been installed in accordance witli the provisions o TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ Z:_..�_<�:.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WIL UN TION SATISFACTORY. DATE.... Z ..y_ ... Inspector..._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................OF..................................................................................... �© No...ef^..:Z3/... FEE....`................. Permission is hereby granted � � = �/ ------------------•-••-•--•---------------•---•-•-----.....-----•.............._--•-•- tc Construct or Repair an Individual Sewage Dis osal System at No/,.... %•-•• ------5'�'�( `cr.v �f/.._ .......g. -_ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... �o f`H�alth DATE---------------------------------•......---_..f 2_ 1=3 `•.._..... 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