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0036 HITCHING POST LANE - Health
3 6 f 73 SMEADI KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT10% CerGfied Fiber Sourcing POST-CONSUMER www�propramorp VD M0ix0 MADE IN USA GET ORGANIZED AT SMEAHOY LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS BUIlDER OR OWNER DA T E P ERMIT I S S U ED DATE COMPLIANCE ISSUED r - 2 2� z�igo 33 � N ..........._ .... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE TH ff?................. : OF..... /r? .:.. ........................................... Appfiration for Disposal Works Tnnitrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /4Y �_ _.1. //��------------------------....... ocation-A4ress / or Lot No. - ....� �,5...... ........G/��,.L((LLL�j����-•Z�F/•----•-------•---------- ..........-•...................................................................................... Ow ................................Address W ✓s `PTe� Installe Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................... .....Expansion Attic Garbage Grinder.. ( ) �+ aOther—Type of Building ---------.1Gpn_ No. of persons._..._ ,.............. Showers ( ) — Cafeteria ( ) dOther fixtures ............- ------...............................--•-----•-•---••••••••-•--•••••----•••--•••----••---••-••-•-•••••....--- W Design Flow.........,5 .a....................gallons per person per day. Total daily flow- .......................gallons. WSeptic Tank—Liquid capacity/ .ot>gallons Length....... Width.... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.............,..... iameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing t ( ) '-' Percolation Test Results Performed by.... lk .., . f_�Z.Ce rl4._.... ... Date.../---- a Test Pit N 1 ...1Q._minutes per inch Depth of Test Pit.................... epth to ground water....................... Test Pit NiJ*. •__minutes per inch Depth of Test Pit.................... Depth to ground water........................ O /�... ......................... ....... .. ..®`.... _....._y______----------. Description of Soil `� .- .../ .........7ca ... .. j._.. � -•------•-•-- W ------------------------------------------------------------- ---------------------------------------.._. U Nature of Repairs or Alterations—Answer applicable._..........:............. ........................................................•.......__. .................................................Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with'theisions of TITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in n until a Certificate of Compliance has been ' s ed by e board 1 g ------ ----- ....................... _ _.. . � Date tionApproved BY ......--- -•....................................•----••--•--- .......� - {-"�7 Date tion Disapproved for the following reasons:............................................................................................................... Date Permit No......................................................... Issued. _............`3 2 Date N -----.- --- w, P FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H . T H _ _ . . ................OF..... f `!+�`• . -...... . ......_......------------._.............------ .� Vrfirntilan for Disposal Works Tontitrnrtinn Pamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at J � ...._._.. -�C . 100.02 :. ............................ ...... - ocation A res or Lot No. f.......l.....-�i....... .k�..+: .......................... .........•---.........----.........-•-----•--- R( Ow Address Install Address d Type of Building Size Lot.................... .....Sq. feet aDwelling-No: of Bedroom§...• ...............................Expansion Attic 4 Garbage Grinder ( ) 04 Other—Type of Building ...... No. of persons....-------------- Showers ( ) — Cafeteria ( ) PaOther fixtures ---------------------- ':----------........------•--•-•....-•----..--- .... ------•---.........---................ W Design Flow.........A;7_5071....... .._..gallons per person per day. Total daily flow..A, .......................gallons. WSeptic Tank_Liquid capacit/PO .�.I.'.'allons Length___-- ...... Width._ '`�''......... Diameter________________ Depth.._.._......... x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No...::.__... _.... iameter-------------------- Depth below inlet .............._... Total leaching area..................sq. ft. Z Other Distribution box ( Dosin Percolation Test ults Performed b /�1!CE '1 Date__...- --•---- a Y Test Pit N -" mnutes per inch Depth of Test Pit..... epth to ground water........................ (i Test Pitt N > per inch Depth of Test Pit........... ... :Depth to ground water........................ �+ } o Descri tior�<of o;l _ - 4, �� W 4 ........................... __.............. ______ __. .. .. .,__ - ....._.--_.. .._ ......................... U Nature of Repairs pr Alterations Answ lrc �.:ppfi ____. , .,•rr`'___......___ ............................•.... } gr Bement Qy' The)undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTLE 5 of the State Sanitary Cod The ndersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss ed b h/ee board �y ----------------------- D to Application Approved BYX •---------------------•••----•--•---_.. ......if......... Date Application Disapproved for the following reasons:............................-----••-•----•-•--•-•--••-•-----••-•---••-......•-------------------•--•......-•---•. ..............................•---•._.....-----•--•-----•---................-----••---•-•-•------•--------------------------------•-----------------•-•---•---••-•-•--------------------------•-------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ...............if Tntifirate of TompliFanre T IS TO C TIF , That the Individual Sewage Disposal System constructed (41) or Repaired ( ) by !!;1'`` ...y-':' t ---------------------•-•---•---- - --------- „ Instal has been installed in accordance with the provisions of m d`�of The State Sanitary Code as described in the application for Disposal Works Construction Permit N --------,-- . dated----..__,,,- ..kt---7d;....... THE, ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY DATE........... -Id.-•-•................. 2...- Inspector-------•-----------•-------- r.Y" 8... ..- _- . ............ ._............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ................ r-�✓' E � FE-•- ............... Dispos V4trk5 n anon .ermit Permissio ereby granted"..... - :L -•-•---•--- ---------.................................................................... to Construc or Repair ( Ijudivi4. sew Dispos ystem atNo... •--. . . f « jE' --------- ------------------------------ ................................. Street / as shown on the application for Disposal Works Construction Per ' - o.... ........... ated.._�'_/ �__........_..:: Board of Heal DATE•. 7. .................................... Y FORM 1255- HOBBS a WARREN, INC.. PUBLISHERS , -If, - I- - I , %;,t Ol , . . ,,. , w'-\�',�-- 1 . , ; .I . - �?��V '+T, , . ,� , ,- -,-�,-?7.�-?!1 1 . -. -,,,,,,L;�,,,�-,t"Y-,� 1 l'71)" !�:,,,l.��.,.,',:.I�.e,?,�0�;,"�.�io'�,l ,�",' 'p, ,,�2,�r;;i,�"'! , "'? k"-;.. ":, " 'i.l. �, ,�, ,- �� t�, ?l,411,�,I" -I "I. , ...... . ,, , �wtl ,1,� ,. , ';;� --,� ", �- ,,v-,rj), i�,,,, ,',�l vo4 I ,� ;- ,�, .� -,,, "I ", i e,� '.A " " ., , , , 11 . I - 1, 1. q F I . -�Plil, . . , . 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