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HomeMy WebLinkAbout0281 OLD STRAWBERRY HILL ROAD - Health (2) as pia si " e� 9)-U92- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE H f11�..............OF..... Apphratinn for Disposal Works Tomitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: [� Locat'on-Address I or Lot No. �� - ------------------------------ _7_c�..... .- w._._. fi g_ Ys aOwner Address......................................... ------ ---------•-•_•-_---•-------_--- --•--------•••-•-•-•-••••----•-------•-•••- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................_...............Expansicm—Attic (,0v) Garbage Grinder (NO ) Other—T e of Building �'�4a �'/1g►w� t No. of ersons-_.l? Showers a YP g --=-•---- --- - P ---------------------• ( )--- Cafeteria ( ) dOther fixtures ......................................................-••------------•-----•---•-------•••--•-••-••-•---•---------- -----•---- W Design Flow................................. _________gallons per person per day. Total daily flow______ ------------------------gallons. W Septic Tank—Liquid capacityl©o...gallons Length-_------------- Width---------------- Diameter---------------- Depth---------------- _ _ x Disposal Trench—No_____________________ Width................ Total Length------- _ Total leaching area--------------------sq. ft. Seepage Pit No...._�_............. Diameter__/ __ epth below inlet----- __ ________ Total leaching area_90___2_____sq. ft. Z Other Distribution box ( ) Dosin6 tank ( ) '—� Percolation Test Results Performed by-------------------------------------------------------------------------- Date........... Test Pit No. 1................minutes per inch Depth of Test Pit.........._--------- Depth to ground water------------------------ (14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 9 ------------------------------------------------------------------------------------------------------------------------------------------------------------- O Description of Soil-----S'44 l.j]____±_GjU_11a f_ U -•••••--••••------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 Article XI of the State Sanitary ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the board of healtiv I J igne --•---•--•-•-------- / s?1- JOIS a 3 . " Date Application Approved BY - v� *Z----- ---- ate Application Disapproved for the following reasons:--------. --------------------------------------------------------- ----------------- -•------------------------------------••---------------•---•------•----•--•----------•------------•------------•---------•------------•-----------••--•-------------•-•---------------•------------•--- Date PermitNo------------------------------------------------- ------ Issued------------........................................... Date 1 No...... 1`1`..""----•. F>mu... ................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appl ration for 43hipwial Worka Towitrurliou runift Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at . g.......... -••.... N _ _° t�. xr__ s p -�P-t t•-A+'. ---•---------•----------------------------- ---- ------------------------------------------•-- Locatjon Address or Lot No. t .. , .. _._ _ v-H . r�._ t I�':5 � � e-y.°tt: ,- -------------- Owner Address Installer Address d Type of Building Size Lot----------------------------Sq. feet V DwellingNo. of Bedrooms_...__ __________________________________Expansion.-Attic a Garbage Grinder V No. of persons _____________(__�_}Showers � Cafeteria ( �)p� Other—Type of Building €A�#:A�__�_?_��x::_::. p ( ) ( ) Other fixtures . •----•--•-•--•--------•--••------ --- W Design Flow............................................ 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 - ref $-Depth below inlet ___; ;g....... Total leaching area-2 r..___._sq. ft. Z Other Distribution box ( ) Dosini tank ( ) r Percolation Test Results Performed by Date Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.--_--_----_____------. r=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_________________--.-. ---•-------•--•--•-------------•---...-•--•----•-•-----••----•----•---------•---=-••------------•------------•-------•-------------------------------------- 0 Description' of Soil - - I-; -, '_•s_ .._ I - 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 Article XI of the State Sanitary,,. ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beej issued by the board of health: - 4ZI Sined. yr' g -;` __---•_____----•-•--- -' -- --' -'- ---- e Date y -; f -------------•--- -,w-...............APPlication APProved B ' -- � Application Disapproved for the following reasons:------•-------------•--------------•--------------------•-•-----•------------------------- ---------•--------- ._._..---••------- Date PermitNo................................ =:..... Issued.......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HE, LTH ......................O F... .... .... (9prfifiratr of f omptiattrr T IS T� CER IFY,�hat the I ividual Sewage Disposal System constructed ( ) or Repaired ( ) byg'"•!a-fie" -- -- ............-------------- .... '--------' ----------------- --------------•----------------••--- Installer, �+7 f c �p at ' s --- - has been installed in accordance with the provisions oft'O'Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........................._y, .___.___. dated--- ,- ", ' -- --� ------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ( !_ Inspector r S.J THE COMMONWEALTH OF MASSACHUSETTS I BOARD F HEALTH� Lwn sv�'! ... ........OF... ' = t i`� .......................... No._�""---.j.......... FEI':--.",,--"-•'••"•"•---- i-4np' = oxk Tatifilrar " aT rr aatt' Permission is hereby granted_ s- -�•, _.... to Constru ( o , Repair ( )� a I divid 1 Sewage�Disposal :S.y� v m �s _ _ } .__-----------. •. - - Street t as shown on the application for Disposal Works'Construction ernt No v � -r- Dated --------••"--" Board oHh;, tea « DATE.----� ,1��--�r--- 3.................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS