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HomeMy WebLinkAbout0048 GALLEON WAY - Health 6E�s�T 1--- -0 41 V LO AT SECJAGE PECMIT p0• "�I '! eIAI 1LLAGE wll�)q12 s-ro Ns ,9:yi Z-/- IHSTA L ER'S HA1IE A ADDRESS 4 8 U I L,0 E D OR OWNER DATE PERMIT ISSUE ' [4 DATE COMPLIANCE ISSUED � - -�3 � I � � U �L r. -No....... FEB........ :......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /ram ..... ................... '. ............................................... Appliration for Disposal Worse Tonstriirtion Vamit ` \ Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal ystem at: .lay' ................. ....... '..................... _s p Lo tion-Address Lot No. ca Owner Address ..,. Installer Address UType of Building Size Lot.._��.!,1s ......Sq. feet Dwelling—No. of Bedrooms. ... ................................Expansion Attic ( ) Garbage Grinder ( ) W Other—Type e of Building -.yp g _.1.��................. No. of persons.....__._..__._.._._.._____. Showers ( ) — Cafeteria ( ) aOther fixtures ------------•------------------•------------------------•----------------------------•-----_-----------------------------------------•---------------- d W Design Flow........... .........................gallons per person per day. Total daily flow............... ................gal Ions. WSeptic Tank—Liquid capacityl4P<t....gallons Length/4..4........ Wldth,S............. Diameter---(a.-_4.._. 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 ._-.__..,._ �.f ,.a Test Pit No. 1.....�......minutes per inch Depth of Test Pit......lo?_..._.. Depth to gr nd water.._✓��^! Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' •-----•-----•---------------•-------••-•--•-•-•--••--•----.........---•--------..._....-------•••--.......................................................... 0 Description of -----.�-9^ 41. .............. ............................................. 1-------------•-----••---------------------------------------.... •---------------•------------------------------------•---•-------......-- W VNature 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 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the War4 of health. Signed---- • .....................•---•--•- /t Z, /_.. __...----•-••-•_._ ... Application Approved B d a� Date Application Disapproved for the following reasons----------------•------------•---------------------------------•---------------------------------------....•••••. ••................................•-•-------•------•-------••--•----•-----••-•---•-•----•--•-------•-•--•-----•--••-----•----------------•-----------....•-------•-•--••---•--------•--------------•--- Date PermitNo......................................................... Issued....................................................... Date No.......4 OR ..1?I FEs........................... THE COMMONWEALTH OF MASSACHUSETTS _�. BOARD OF HEALTH u! ..........................0 F. �S/e/57/5lf... Appliration for Disposal Works Tontrnrtion ramit Application is hereby made for a Permit to Construct (y ) or Repair ( ) an Individual Sewage Disposal System at: ............. _......1.---... �' ...... - �'��'7. 5 r ��� ... - ....... ....._._.. ... Location-Address ,2A.................................... c�%t/ .•-.a. y / S � / o------ ( Owned Address - a ................................. - ,, ............................ .....-.-.---------------.--........ Installer Address UType of Building Size Lot--- .......Sq. feet Dwelling—No. of Bedrooms._..........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building 16®S No. of persons ................... Showers a YP g -.---------------------•-•• P ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------•-----•-----------------------------••---•--•-•--•---•••----------------.....---•-----...------------ W Design Flow........... ..........................gallons per person per day. Total daily flow............... ;................gallons. WSeptic Tank—Liquid capacity!PQQ....gallons Length!?_4.._...__ Width•s............ Diameter.._6---:----- 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.....................................................' ............... Dat ... Test Pit No. 1....s....._.minutes per inch Depth of Test Pit...._/ ..__.:_. Depth to gr and water___ ..... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --------------------------------....................................................................---........-•-.....-••••-----......•--................... O Description of Soil.L�u&_ 01.L,---Za ............................., % n --./.y —'`'�''! -�_.... x U -------------•------•------•--------•-••-•••---•------------------......--.........------.....•---------•----------------•-•--•--------...----•-•--•--------......--•----•--------...........-•-•-•----- W UNature 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 T Z4 y g g p y S of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been . s ed by the ar of health. Signed......---•----•----- �/1, �f -------••--...-- ;� .......... O � Date Application Approved By........ �.. ''t� ' �" •, � .'............................. ---------•- Da Application Disapproved for the following reasons:-----•-07----------------------------------------------•-------•----------------•------------D-- •te--------••---. ....•..........................•-••••----...---•---------•-...--•---------•--•-•------.......------.....-'-••---•-....•-----•-••---------------•-......-•••-•---••-•----------•---...Date PermitNo.......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ......................O F... // rr..'y.=�' � '1�..Cam............................. r �rtifirFatr of Tom-pliFanrr THIS IS TO CRT, FY, That theIndividual Sewage Disposal System constructed or Repaired ( ) byr .�•==' ._.. ,-�. .------------------------------------------------------------------------------------------------------------------•------------ Installer at_._.... '%...._ - irl e�'cr.c/ 1�... /ll !!s..........................................................�S has been installed in accordance with the provisio s of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._es:._ _r,F_J?................ dated.._.-_-___-_-_-__.-_-______-.._--•---_-_-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEEYTHAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................... � ............. Inspector--------......---- e ............................... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH lOccJ�✓ ..........OF.....�Z/e y--5/�.`�•�''� ro ,S , Disposal Work. on tr wit prrmit Permission is hereby granted..;r....�'G°--- �`-�' "r: i ............. to Construct (�� ) or Repair ( ) an Individual Sewage Dis osal System for �?/ 6f��l.�r� at No...:.................•-•----_.. . ......---••-....•-•••-------w. /-j.�e—e—t—--------------•rL.s Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... /---------------_-•----_ . a ......l DATE....................... ------------------------.... 7Zard of Health « FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ - g . r _ ,: . :.. ,.,.,. ,..- ...:_ 1• ea..�. �...�� sxa ►J Aarc MF,ai..l SSA L.cVOL. IPITC-W Au-- t-lLiEs A M i OK ► A L L- Pt PE5 -ro' A.►.1 t� 't i TY STD N1 _51�Ar11.. O ( 1 _ - t"SE C.�ST t R.�•.J � �:,.N�OU�..+� AO P.�J G. 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