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HomeMy WebLinkAbout0143 STRAWBERRY HILL ROAD - Health 143 Strawberry Hill Road Centerville A= 247 — 139 N No. 42101/3 ORA ESSELTE 10% 0 o a a V f d 1 1 ,t II .. CG TOWN OF BARNSTABLE L XATION / !L'-7 S`%rr'Ei— l2=r C�r; /`�j%f SEWAGE # q6' VILLAGE aw� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 41 SEPTIC TANK CAPACITY G J LEACHING FACILITY: (type) !; © 42 . (size) , NO.OF BEDROOMS _ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: OL Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t � - ���` •- _ � � �) '�`r>�� Y a � 1j� � � � � �� ��� , �. _j TOWN OF BARNSTABLE LOCATION _T'7 J r + , r'�;r w`f: l j %j SEWAGE #J00, VILLAGE 9 C' � ASSESSOR'S MAP & LOT r , INSTALLER'S NAME&PHONE NO. /D2 h C if 17 S / c- SEPTIC TANK CAPACITY 'L J LEACHING FACILITY: (type) % c /`<<% 42 111 cam— (size) 64, NO. OF BEDROOMS_ _ i BUILDER OR OWNER PERMIT DATE: 619 COMPLIANCE DATE: i Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility..(If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching'facility) Feet 'Furnished'by Q � V 7,T1 i f i J im, IL Fm$....1`. THE COMMONWEALTH OF MASSACHUSETTS .-,BOARD O HEALTH ............/. a,-) ,....OF.........Z� r .,'%4 -- -• ------•--------------- Applira#ion for Dispas al 10orkii Tnnitrartion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (j,<an Individual Sewage Disposal System at: P /401,f.......................... ......- //-/-9 �Lopat' Address or Lot No. W .......7of :. 1d3� I I : ...................................o ... ..........----------...-•---.............................................•.....-.................. -•......................••......Address Installer ...------•----•.................MAddressVTypilding Size Lot............................Sq. feet Dwellingi;11o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildiii a Other—Type g ____________________________ No. of persons_......................... Showers ( ) — Cafeteria ( ) Otherfixtures .---.....-•...................•---•-------•--•-••---•.•••--•-•-•••..................•-- 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. 1................minutes per inch Depth of Test Pit......---........... Depth to ground water..------...........----. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---..........--......... -- - ------- Descriptionof Soil ......-•---------------------------------------------------------•-----------------------------------------------••••-••••••-•---•-•-•- x U -•-••-•-•••••-•••-•••••--•--••••---•-••-................................................................................................................................................................ ----------------------------------------------------------------------------------------- ------- / - U Nature of Repairs or Alterations—Answer when applicable---!____-_jr1.=./QIJ -...._.__�:.�... ��..._._.... ----------------------------------••------•------------------------•-----------------------------------••------------------------...----------•-------•---------•----------------------•---•-•-•--•••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of= IZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by t boa of health. Signed --- ........./.� . ate Application Approved By.. 1�� —---------------•-•-•-------- �����-� Date Application Disapproved for the following reasons----------------------------••-------------------------------------------------------.....--••••................ .....................................................................---------••---------•--------...---•....•••••--•••••--••---••----•••••......------............--................................ Date Permit No.....2.y.:.! � ...................... Issued........................................----------•-•--- Date FEic /.. .� : ? THE COMMONWEALTH OF MASSACHUSETTS ---BOARD 9,F HEALTH r;•1.. S �....OF........ .: .f�lf: „J._..__... Appliratiott for Elispuiial Works TomitrurtionarAft Application is hereby made for a Permit to Construct ( ) or Repair (4,,i"an Individual Sewage Disposal System at: ....... .'G....a.��....Y. .. .l...a..¢1�'+F. 64....... .?°A :':?YI -......._.r..i d-:' tC� ? ............................................................................. ,f� d Lo at,o).SJ=Address or Lot No. J �JI _I er ! t' .. -Address gay p f'� �i. W 7 „lt C ___Jz.. ....:v" ................................................ .............._.._._...._............__.. Installer Address dTy of Building Size Lot............................Sq. feet U Dwelling�o. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) �+ 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al 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 ( ) Percolation Test Results Performed by------------------------------------------ "-----"- .......... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - D Description of Soil-----"--"-" .:. . .................................................. W U x •-"-•-•----•--------...•-•••-'-----•--"•-••-•--••••-•------•-------••--•-----------•---"----•"-......••---""-•• "- --------------- U Nature of Repairs or Alterations—Answer when applicable___ .____t l_ =`_� 'jv'-' .._._..___ :� ". �``� j ..........................................•.............."•-••----•-•-'--•--------'"-•"--""""-""--------""----"•......--•••'-----•-•-"--•--•"-•"•••••----•---•-•----••••-••-_...-••-•"....-"----"-•-•"-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI1- 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 bo ro of health. �f Signed. ._ '' .._.. '`. °�` ` " ' lol �/�-. r�%...d Application Approved By �rs tJ t1h� r :t, - ! + ------• • 4pite ate Application Disapproved for the following reasons:--:_...••--:---------••---"---"•---"--•-•--•-•••-•-"-••---•----•--•---'"•••----"••-•--•--..__......"-"-•..._... ....•..........-•-•-"•"---------•......................•-----"--------•--..."--...----••••--"-"••-""........-"--"-•-"•-'---•--•--'-•-------•-••-••"••------------------------_......."•••-••"--•--"._.._. Date Permit No.__ ../_..._4L0.� , Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD���/' HEALTH r '....... ..::.. ..OF....... ..." ...... .......... (In ifiratr of Totttphaurr THrL� y TC� ERTIFY,, 'hat the Individual,Sewage Disposal System constructed ( ) or Repaired (/�✓ by...._j/�. -�'�to fi''�� ,� � ' �N....-- ,.... .-- """-•"-•"•••"•"•"...................""-..._--"-- �/ Installer a . • has been installed in accordance mirth the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ........... dated_...1__fIZQ . ..:a...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS ACT T. DATE............................................�f . .__ _4_._.... Inspector...��---•----------------------•...-•----------••----•----••-•-•- THE 'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i',`Ir 'et r.....OF..........`x/.._.:° r " ' f................................................... t�� FEE. ....... .......... Permission is hereby granted ��� r`. - -..° f+- .r........................ to Consirruct ( ) or Rep/a ,,(r' ) an Individual Sewage Disposal System , at No. /_ •. f--------+:-"`-'•�'f1,`"r*yi",r:✓' 1,- -,,.s ,•f ° d ✓` i --"............. ,! � Street as shown on the application for Disposal Works Construction Permit ..__ Dated._ ------------------ a. � _�'._�-1titi_ T-.sf•__ !,_ .1 t.`eT................. oard of Health DATE........................................................... -------••-""=----- FORM 1255 A. M. SULKIN, INC_ BOSTON �fl ? CAT10N SEWA E PERMIT. NO. L/ ji? & �s i2,'Q , H 121 eel-io G 8 VILLAGE INSTA LER'S NAME i ADDRESS e UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i� l j — i ► � � oy� , 9; � s � �`�3, ®- J`, ..^�' � � ,.r