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Home My WebLink About0207 STRAWBERRY HILL ROAD - Health (2) 7 3�PW S ASSESSORS MAP N0:-0 L4 7 g�60 PARCEL N0: r� i [n = .........0....7_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....i.... �-!........ �----------------•-.................. Applirativit fat Bispm al Marks Tomitriirtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (k-,) an Individual Sewage Disposal System at: .......� .. 7._...........67�i�i(yk; �'E�'�.... ��_.. �.. ............ ................ Location-Address or Lot No. ..........ice � .__...... '--.z lei ----------------•---------- ••---....----Sa ------•----......_.--.......-----------------...........------------ Owner Address C P L. icvY? _: :`t �2 ..__ 5 a��.-? ....,�r4' 4 -------•----------------- •---------•----------------• -----••----------------- -------_... Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms------3..................................Expansion Attic.( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------------------------•----••-•-•--------•---•------•--------••--•••••--••-----•-----••••--••------------......._......--- w Design Flow.......... S. ..................•..gallons per person day. Total daily flow....... _ ......................gallons. 9 Septic Tank-l-Liquid capacityl--- .gallons Length--- .......... Width-_V._._..... Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I............. Diameter...40....._._. Depth below inlet.....e.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................... (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-___-.---____-:---__-. Q+' •-•----•--•-----------------•-•------•-------•-•----•-•---••---••---------------•---.........._..•••......................................................... 0 Description of Soil....................................................................................................................................................................... x U -••------•--------••-•-•••--••••-----•------•--•--•...-••-•-•...-•••-•----•-----••---------•-----••--•-----------•-------•--•---•-•-•------•••--------................................................. w V Nature of Repairs or Alterations—Answer when applicable__:---;:.5 �_.itc��_..►. _� Fli` _._�_l �c ,_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with R1T/1c--� the provisions of T IL4 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 b e board of liralth. Signed fir........ ................... ........ -3��:: Date ApplicationApproved By... ............. -• --t..... . --•--- ••----•--------- . -•-•------- ........................................--•--•-•------•-------------------•----- Date Application Disapproved for the following r ons:--••-•---•--•--••-•-----•-------•--------•--••--••-•••----•---•---------••--•-•------------------------------- -----------------------------•--•----•--...---•--•---•••-----...---••-•-•--------._.....--•---......_.....__....._...........--•--••••-- ------------•-•••-••--•-------------••-•••---••------••------- Date Permit No.--•---..U_.7(5?.7-------------- Issued------------------- ................................ R r Q Wf No................. 6 6 t [Q Fes$..... _. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...._...OFj .YLy�S114`L,`-� ApplirFation for Disposal Works Tonstrar#inn prrmtit Application is hereby made for a Permit to Construct ( ) or Repair'an Individual Sewage Disposal System at: Location-Address or Lot IVo. Ov6rie� Address------------------------------------------- a C_f---t�_ ._.>..A.vu0---- ... --- 3 'z�n.�„ti s.....R rye Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................... _.__.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................. No. of persons...._----------------------- Showers — Cafeteria P4 Other__ ------------------------- ....................................... W Design Flow..._..___ _____________________gallons per person per day. Total daily flow...... 3.(--)......................gallons. 9 Septic Tank 1-Liquid �capacity .gallons Length..2......... Width-_y.......... Diameter________________ Depth................ Disposal Trench—No..................... Width.................... Total Length............7...... Total leaching area....................sq. ft. Seepage Pit No------/............. Diameter... ----- Depth below inlet.....4........... 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___-_________-----._--. (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ....................................................................................................----•------•----------------•-•-----••-•------•-------•----------•------•-•-•-•............._---............................................................. 0 Description of Soil........................................................................................................................................................................ ------------------------------------------------------------------------------------------------------------- ------- --------` ----------•--------------------------••----••------------••••. U Nature of Repairs W Alterations—Answer when applicable.___itiSl_N4 4____L6�. '. .. -lC...S_k`Ww _._.. IS ?� we to ......................... Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of iT I E i of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued oard of 1 alth. 3 =ee Signed--• ----- / = == •---••-------• ................................ Date Application Approved By /lr. ..._...�A.._:_..... �i i�.r:-.----•-- Application Disapproved for the following ons_..........._................................................_............................... Date.............. -----•--•-•------•--------------------•-------------------------•••---•--•••---•-------.....-------------'-••------------------•••----------•----••------------•-----•--------•------••------•-•...._..._ Permit No. Date C�1 -----....... /j- Issued LSi.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF. . >. 2 v`.s`�u Tnrtifiratle of Tontpfiatnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( L.).- by_....__... G '�-----{_V, • ;,----5,w- .............................................................................................. at....................... ------•---------------•----------------------------------- has been installed in accordance with the provisi'66ns oi, Il,C; '-o The State Sanitary o e as scri ed in the application for Disposal Works Construction Permit No.96.—, 11TRUED ....... dated__.. .. . ................. TFIE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON AS A ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. : ............. f - �..-V.... Inspector.................... ............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �T � v 'O' y :.....O F.. .V1 VV_-�S:•:t...f� ........................... FEE.................... .. Disposal Works TUontrttrtion .rrntit Permission is hereby granted----••--•ff y4-�j�...L._Ayc -------- �a ...--•-•-•........................................•----•-•--- to Construct ( ) or Repair L��n Individual Sewage Disposal System at No... � 1 1 .................... �1 L,'-...._...� d'. ....�..1..�-i------- ee KZil C7 - --------- as shown on the application for Disposal Works Construction Per it ated__._____ _..�..... .............. l�� f 1! j- oar Healtli v DATE--------- - - --.. . • ......------•----........................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS