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Home My WebLink About0570 OLD STRAWBERRY HILL ROAD - Health (2) � U c 11 � o r, R . C` .P 4. . ` •• •. ., - �r '!1 � :.a ,. -_ a ^ , 153113 RED 10% P4 ( THE COMMONWEALTH OF MASSACHUSETTS` p�� BOARD E HEALTH V _ Appliratiun for Disposal Works Tonntrurttun jinnfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �> ..A ®L _S-E fw.�e l� ----------------•------ - ----.... ��------...................................... Locatio Address V oto. �� Owner A d a ..... .........R. �. .......... ......_..... ....... W ✓j_ �Q� �� Y, Q/n�u/ ........... Installer Address Type of Buildings Size Lot_10 Qo!..........Sq. feet Dwelling•s�No. of Bedrooms.... .....................................Expansion Attic ( ) Garbage Grinder Wo P Other—Type of Building ..... No. of persons /................ Showers a YP g ---------__ P ( ) — Cafeteria ( )_ dOth�r fixtures -•---....-•-•--•-------------••-----•--•-----------......-•-•------•--•--•---•---------------•---•------•-----•-----•----••......-----....__.....•---- ' w Design.Flow ....................•....._..gallons per person per day. Total daily flow__ g g P P P Y Y -��-�---------------------•-----gallons.., .: WSeptic Tank—Liquid capacity//Q-®.0gallons Length................ Width................ Diameter.............. Depth................ x Disposal Trench—No. .................... Width_. ...._......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......f............ Diameter.........:Q.__..... Depth below inlet......4_.......... Total leaching area.r..�.O-/-----sq. ft. Z Other Distribution box Dosing taj4k ( ,,) s� '—' Percolation Test Results Performed b ._.._.__ 1 ...` .✓Ye _ Date....J -�tV Test Pit No. 1----A......minutes per inch Depth of Test Pit_____............ Depth to ground water________________________ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........................7------------ ---------•- - , .. --... Description of Soil Q 19M••-- c�0 ® C� p -- ----------------------------------------------•--------------- w ------------------------ a c ' '1 :✓ VNature of Repairs or Alterations—Answer when applica.ble___________________________•---_-._______-.----_-___........................................... ---------------------------•-------------------•----------•---•--------------------------•--...------------------------------------•----------•--------------------•-----••-•......----..........•--••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ,, 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 e bo d of health. Signed...... ' �� ••_ ate Application Approved By...-...... .........C... ..__ _ / Date Application Disapproved for the following reasons:-•-•--....-•---•-•-•---------------------••-------•------•----•-•---------------•-------•---•-•-•-....--•-.----- -•---------------------•--•-----•-•------••------------•-----•••--••••---•••---------•--••----•-------------••---•-------•• ................. Date Permit No-----------L L.................. - Issued...>�.��.....` s'. Date 7 siD No FEB.......!=A...'..-.. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ....... ......)�...OF... .. .----------------------------------..............._ Appliration for Disposal .arks Cnnntrn.rtinn Permit Application is hereby made for"a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal systemat: .......................................... Locati Cd re �. 1- 3 alyd.GIv o : ... ................ ......... ..........•• , ------------...-•-----•--- v Installer Address. Type of Building, . Size Lot............................Sq. f et Dwelling No. of Bedroom _____________________________Expansion ttic ( ) Garbage Grinder `r Other—Type of Building �:___.. No; of persons______________________ Showers ( ) — Cafeteria ( ) Q' Ot fixtures ----- d Design Flow.____ ,__15:__________________7� gallons per person per day. Total daily flow__........................................gallons. WSeptic Tank—Liquid capacityCgggallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width__ _._____..__.___ Total Length__.__.___._________ Total leaching area ----- Seepagesq. ft. Pit No.____ //_ Diameter .__.__ De th below inlet_.__.6.__:.__.__. Total leachin area_°Z_..._j•__...s ft. � f-------�.. P _ g q• Z Other Distribution box ( " ) Dosing t '-' Ve Percolation Test Re 1 Performed by....... .... Al, - ." + Date___ ._� aTest Pit NO, 1�_.__--------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........................ wr I `` D Description of oil.... . t ;Wil j U c / .............................................................. x --------------------------- --c-----��-- - ` "'� v •-•••-•-••--••- w VNature of Repairs or Alterations—Answer when applicable............................................................................................... ---.............................--••-----------•-----------------------------------________-----------------------------------------------------------------------------------------------------_-•---- Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL%, 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 Ae rd of health. / !J f r 4 J Signed .. ... --------------------------- ----- ------------- I Date w Application Approved BY "__ _ .__.__...............................__.___ ...._. --- • �"'- Application Disapproved for the f oll`owing reasons:_____________________________________________________________________•______•__•----•---•.Date._......_..._. Date f Permit No.......... •_..... Issued....�K ---• ----------Date--------••..................... l THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD IF H/EA �TrtH ... ......... ...................... ................................. (9rdifiratr of fl omplianrr THIS T.IFY That the Individual. Sewage Disposal System constructed ( ) or Repaired ( ) by ` : ............................ ...................... ::.. In come at••-•--•••••. •• -• _... . I Q'�' -- ••------ -------- -------- ••------ -------- -----•-------- has been installed in accordance with the provisions of T5 of The State Sanitary Co4esc7d in the application for Disposal Works Construction Permit No. ,:.__ ........ ________ dated----_______ _________ ......._............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNY-X N SATISFACTORY. DATE -1" CQ� -....-`•--�-�................. Ins pector...... ........................................................ THE COMMONWEALTH OF MASSACHUSETTS �" BOARD O E T k r 0 '? .. ....... OF...... ........................................................_._.. ; No......................... FEE......................... Dispolia #XIInstrudivul- Permit Permission is hereby granted ..............5 ---•--- to Constru 9r)R r,( ) t%, dl�r d I Sew spo � / �f�%4 „ �/�/j "rt' at No........ ..............................................4� ..-•----. ...--•----- ----- -------- •----..................... t}► - - tree' 74 as shown on the application for Disposal Works Construction it N Dated__________________________________________ •.-..........................._ / /' Board of Health,/ DATE._...:--•--------••-•-----------!/-�. 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