HomeMy WebLinkAbout0142 STRAWBERRY HILL ROAD - Health 142 Strawberry Mill Road
647-162 Centerville
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LOCATION_ SEW A PERMIT NO
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INS TA LLER'S NAME A ADDRESS
B U I L D E R OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE> ISSUED
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No.. ^ 2 F>s.. ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................................O F.......................................--------------........--
Application for Disposal Works Cnnntrurtinn Prruait
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......... ' !Llt .....1 TF'`G--.�! ..S .....4_7.-i,/:'ff `...........................•----------•------
Location-Address or Lot No.
.._. .! C rl:... ------.......,a1 -T dll�%"e.........................................
Owner Address
al j tu'..._.. !W?s......?!:�.................. ..........., !/� %fit-3. L............................................
Installer Address
Type of Building Size Lot................... .....Sq. feet
U
,.� Dwelling—No. of Bedrooms.............. ..... ..................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
p' Other fixtures ........---•--'-------'-------------------------------._....---------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length.................Width................ Diameter................ 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........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---------------------------------------•-------..........------.....-----------....------------•---.........................................................
0 Description of Soil.........................................................................................................................................................................
x
U •----------------------------------------------------•--•----....--•-----•---------........-•-•--......------------------'--------•------------------...----------------------...---------•'-.._....
U Nature of Repairs or Alterations—Answer when applicable........
r l ------tx4l..... ........ Qp U /-........jr-.. --------------•-•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT r E 5 of the State Sanitary Code—ke undersi ned further agrees not to place the system in
operation until a Certificate of Compliance has been is e y t Va o lth.
gned. -• •. --- -� .. .... .
D
Application Approved By...... ls�. ........
..._._...--'-' --------
at
Application Disapproved f th f ollowing reasons-------------------------------------•-------------------------------------'----------•-"-...--•------...._.....
-----------------------------------•-----•--•---.....-----------•------------------.......-----....-----•-"•--'----------------•-•---"-'------•-'•-'----'----•---"-'-----'--'------•'------'-------•-
Date
PermitNo......................................................... Issued........................................................
Date
- --A
No...3 J Ems./ ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ----.........................OF...............................................
...........
Apptiration for Bhgpos al lgorkg Tnnitrurtinn 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
a�'j " d!V 5�tAu�... . : .. .. ..... .... !.`... ?1.. ................ ....--........Aiw a .........
/ ,Location-Address � or
.� No.
......................................................----------.� .:u .:J ...........•-^^---•---..__......._............-•-•-•. ............C .....
O ner Addr s
�!�.. .. ....... .............................................
.....__.._..._..._.._... -.417TA.d_.... ............
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............. ....................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a4 Other fixtures ---------=---------------------• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ 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 ( )
a Percolation Test Results Performed by.......................................................................... Date---------------------------------
-......
Test Pit No. 1................minutes per inch Depth of Test Pit.................•__ Depth to ground water_-_____-___-_-_---___--.
G Test Pit No. 2................minutes per inch Depth of Test Pit............._...... Depth to ground water........................
--------------------------------------------------------------------------------•----•-•--•---_..............................................................
Descriptionof Soil.........................................................................................................................................................................
x
-
-------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable /Wo -- �" x/gjV'-6
............... ........ -- l a ----.-sT•-A77.................
Agreement: `
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE, 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 ed'liy t .b a of_1 lth.
,,,� agned ..................... . .. ----------........--,�-...�..... ......
.. ..... .�...................................................... ...............
k"e r D
Application Approved By______________
Application Disapproved f o3' th following reasons---------------------------------------------------------------------------- ------- ------at.e-------w------
.......................................•-•----••-•----•-----•••--------------•---•--------_-_..._..--•---------------------------------------------•-•-••------••--_.....-----•----•----••-•---•-_-----
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................I.........I........_OF.....................................................................................
%rrtifirntr of TompliFatta
THIS S T EKIFY, That the Individual Sewage Dis sal System constructed ( ) or Repaired
:.: (/ fr ..............-- •---.. ----
by -aT�_
at ra•t, ._ d.-::.....------ ----------------------------------------------:. ZLb
.........
has been installed in accordance with the provauJof TIm ,, of e State Sanitary Code a6,de4in the
application for Disposal Works Construction Permit No......................................... dated_.. --- -----.-----`- `
_ THE ISSUA CE F THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A ARAIdTEE THAT THE
SYSTEM 1dlIIL FU TION SATISFACTORY.
DATE..... .. �? ................................................
Inspector..- ------ •-•------------------•-----•-----------------------•----.........----•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..� .....................OF....................... ............ �►� ....».,
No............... ....... FEE..............
�i��rla�tt �rk� �nn��rnr#uan pranit
Permission is hereby granted_.._ t�q�s 71- .
t ------------------------------------------------••-•-................
to ConstrueA
or Rep ..(�" an Iadivldual�Sev��getsp ystem
• �Zorks
.-^---z:. ......... ..................Street
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at No. � . .........................�s � 1
. �`---•----•-
as shown on the application for Disposa Construction Permit No................:.
----------------------------•----••--••---- '
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DATE......................................................................--- ----- of Heath
.-t FORM 1255 HOBBS & WARREN, INC., PUBLISHERS '
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AKRO- ASSOCIATESARCHITE -22
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310..BarnsfaW Road; Hyannis; MA 02601
tel, 508 778.b060 : . .," fax 508 778 2558
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'tel.:5:08 778_6060 fax 50,8-778 2558. 36F 3
V Steven M.Shuman RA Alice L.Oberdorf,..R'A M