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HomeMy WebLinkAbout0084 GALLEON WAY - Health G U C-)-k-6� ®' i - �� -7 - i i I LO VTON SEWAGE PERMIT NO. V I L L A G E C)7 o� INSTALL R'S NAME i ADDRESS , B U I L D E R OR OWNER DATE PERMIT ISSUED /-Za7f� � ® �2_ D A T E ? COMPLIANCE ISSUED FINAL TN�PECTTQN, PLE,A$F, i D 37 iZ G' 4 � J 7 � E- y 4 No......Z-._2 .............�' .............._ THE COMMONWEALTH OF MASSACHUSETT$ BOAR® OF HEALTH cv, .---....----_----------OF- �,:;;Ty�•s�'� -------------------------------------- Appliratiou for Diipn.ial 19orkii Toni trnrtinn ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at f.............. ... .......!-�:5�-----......._..........__.._..---- ocation-Address r t No. 0 .... .. _k� ems? -• wn - e ---� Address Installer Address Type of Building Size Lot._._ . j____Sq. feet �.� Dwelling—No. of Bedrooms______a.....______.....................Expansion Attic ( ) Garbage Grinder (vo) `4 Other—Type of Building p., yp g ________________ No. of persons.........9............... Showers ( ) — Cafeteria ( ) Q' Other fixt es __.................................................... d w Design Flow............... �.........................gallons per person per day. Total daily flow----------------- 3 ___._______._____gallons. WSeptic Tank—Liquid capacity/_gallons Length... ..&_. Width______._._ Diameter_.6__� s�____._ Depth_ . ...... x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No--------------------- Diameter................tR_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) '-' Percolation Test Results Performed by. _.__ �1 _____ ?�a= _ _._.____ Date___/wat a Test Pit No. I___r�_.____.minutes per inch Depth of Test Pit_.__zz_`______ Depth to grounrya"J_�.__.__. GZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --- - / ----.. _..._ Description of Soil. ..... 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 TITI,% 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 t=aoflth.Signed-- ---------- .----•-••----_---- � f- ............... Application Approved By............ at Date Application Disapproved for the following reasons: -------------------------------------------------------------------------------------................. --------------•-----•-----••-_--•_.._.._....---------..._..-------•---•----------...------------...----------------------------------•----------•-----------------------------------••------------ Date PermitNo......................................................... Issued....................................................... Date No......�'':...r F>$..?5..:...::........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................OF.. J..� �J.E��C' .._..... .... ApplirFatiun for Disposal Works Tuntratrtiun rrntit Application is hereby made for a Permit to Construct (��) or Repair ( ) an Individual Sewage Disposal Syst at: ............�.y ... .........................................................,............. .................. y •-::• '`': -s. Location-Address rL , ot No. � / . O ............................................... ....... ,X� ............................ S.. .,._ wner Address a !r......�.. dtZI ........ ------------------------- Installer Address UType of Building Size Lot.... .3? Z....Sq. feet Dwelling—No. of Bedrooms...... .....................Expansion Attic ( ) Garbage Grinder (a�) Other—Type T e� yp of Building ........g................. No. of persons.........��................. Showers ( ) — Cafeteria ( ) Otherfixtures:11 ----------------•----------------- - ...----------•-•-------------------------------•--•-- W _ Design Flow...........`'.............................gallons per person per day. Total daily flow.___.._....... �v._...............gallons. WSeptic Tank—Liquid capacityZ�M.--2..gallons Length.A...L... Width-s .......... Diameter 0_..?_..... 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 to ( ) �-7 Percolation Test Results Performed by- .....uk?�? ............................................... Date.../wat/er Test Pit No. 1...tz2--_-----minutesperinch Depth of Test Pit.._.��.......... Depth to grounjPJ_'�...... 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ;- --- ........ ............. ......... . Description of Soil'---`=•'-'�.... = .......c v !' ...... F` ............................ 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 TIT 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 th boa of lth. Signed. ........................ ... .....�.---...--------•-- �a<" ��� Date Application Approved By.------. = } Date Application Disapproved for the following reasons-------------------•-----------•--•--------------------••------•-----------------•-------- -••--••-----••--- ....-••----------------------•-•-...------•-••-----------••-----•---....•-------.....---•......-----•--•-------------•••••••-••••----•-•-•-•----•-•----------•-------•--•••......------•---------•------ Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF.. ! W .........:........ ...... Trrtifirate of ToutpliFanrr y THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,\-I or Repaired b .T......a. ...... ✓......... ----•------ ...... !?1. Installer at................................................................................................................................................................................... .. has been installed in accordance with the provisions of TIT j"; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.!rs� —_ !_; .............0 dated....................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CT RY. DATE..........................................•-•-•---� , ..... Inspector................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/� NO S .�!..>.. .. ...Ie lmxx...................OF...... �5'� -�"j��!, 1 ................... FEE.... - .... Disposal Works Tons udjon rrntit Permission is hereby granted. ��! a =- � ' ' to Construct (k) or Repair ( ) an�Individual Sewage Disposal System at No.•--•1= .......i "�...-- ,/ 19 -�%Gi°r/5 c .. �s.. 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