HomeMy WebLinkAbout0141 ROLLING HITCH ROAD - Health 141 Rolling Hitch Road
Centerville
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UPC 12534 '
No.2-153LOR
HASTINGS, NIN
5EW& LE PERMIT_ I.10_
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i . _DATE PERMI-T -1.5SUED- �
-___D..ATE. COMPLIAMCE. IS-SUED:
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H HE COMMONWEALTH OF MASSACHUSETTS
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Application is hereby made for a Permit to Construct (L-)�or Repair an Ind
System at:
ocati dress or Lot No.
il�
' S�� feet
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Installer Address
PQ ^/'_ -- __---* _- ` '-_ �
Dwelling--Nu of Bedrooms...-_~=�------------------------- Attic Garbage Grinder ( )
04 (}8zcz--I}pe of Building -----------' No. of persons............................ Showers ( ) -- Cafeteria ( ) �
Design Flow. .~5 3D.
Septic ^ ^ '' . ~
Disposal Trench NuTotal �.
-------
Seepage P� I�o---------' ��� - I l ------sq. �.
�� {)8z�c Distribution ( ) � Doe' �uok ( ) ^��»~ ~*�'^/-' ^��
^� I`ercnlutio� T�t }lcuoltu Pc6bcozcdby------------------_---------------' Du1�--.�--------------..
Test Pit No. l................minutes per inch Depth of Test Pd.....-------' Depth to cr0006 water----.-----_.
Test Pb No. 3................minutes per inch I)coth of Test Pit..-.-------' Depth to ground water-_-_----_-
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... ......................................'............................................................................................................................................................
Agrzcozcoc:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iu accordance with
' the � i of Article of the State Sanitary Code undersigned
operation until a Certificate of Compliance has b7 issued by the boar ealth.
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Application Approved Bv- �
sons:C64%.AL-P
Date
Issued......^........ ...................................... �
Date �
__________________ __ _ __
No...... /....... F>E /. .
5-HE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE ' ofw
...............O F.... !. fC-- -------------- --- -
Apptiration for MoVagal lVarks Tonstrurtinn Prrutit
Application is hereby made for a Permit to Construct (L.)�r Repair ( ) an Individual Sewa e Disposal
System at
Locatiio?n/ .dress or Lot No.
> ` Zsl'aller
r Address
Address
!�4
Type`of,'Building Size Lot....!' '!` .-Sq. feet
Dwelling—No. of Bedrooms...........5...........................Expansion Attic ( ) Garbage Grinder ( )
p-, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P., Other fixtures ------------------------------------------------•. -- -----------
--------------------------
W Design Flow...............S i ...................gallons per person per day. Total daily flow.............. Qr_,).............._.gallons.
WSeptic Tank—Liquid capacit�,,_ .jallons Lengthi __.-_ -_- Width__................ Diameter________________ Depth................
x Disposal Trench—No..............,�it �..,Width ! � Total Length ,,.�``.. Total leaching area.....�0. ,-_-.sq. ft.
Seepage Pit No...................%Uiarh`et"err ti'tbelw.,'n�l �.. Total 1.eachingarea....._..__.......sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) Q,- �G/*, - - </ /7�
aPercolation Test Results Performed by......................................................................... Date........................................
Test Pit No. 1................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........................
... -- • ---------•-• ....-•-------------•-.._......_
Description,of Soil........_�kr' !� 71t /�s' f• { *°. 'f`
U -------`••.. -•----� '�*s y rsG a✓` .. -- ......... lr�a` , .. U
W1.-'....l -� � � z -- ..................................................
�_
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 Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the lboard,-of health.
yrK
Signed � " Z it '------'r
Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------•--•-•......-----------------
-•---------•••--•-•---------------•--•-•------•-•---••--••--•---•----------------------------------------
------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTI� Ice�-'
01
Cnrrtifiratj� of Tomptiattrr
THIS IS TO CERTIFY, That the Individual Sewage posal System constructed (L.,)or Repaired ( )
...
y- � Installeid'L �''rFs �� �`.,� d - �
- -----------_----------------
has been installed in accordance with the provision/Of ArtA XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.-_C 3'_.4h'f_________________ dated_...-.,?_I-___1:�______--. ---_.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................•-•---•-•----.....------.........................---------.. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
��'
BOARD RO f HEALTH �'
w ,f ............OF..... .. .. . FEE../..(I
No..••..................... •-------.....
Permission is hexeb granted �,1-• _ ,,� ................. `.,. ,�,.��- &0-ege .....
to Construct .(E✓)pr Repair ( ) an I iyidual Sewage/Di�pdsal 'ystein
at No.. `mo t - t'.-- •----.-w .....9 s �'�'" "� f! Il
z.� -
f 7 Street
as shown on the application for Disposal Works Construction mit o....
--.... Dated- --:.:z:.'�/...�--------------••----
-�... -----•-/.. !- . ....
�e
DATE.....7L.I1.1.75-- Board of--------•-•--------•-•••-•-•-•••---•-••-------- ��.. /�'✓ — / rd
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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