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Home My WebLink About0161 ROLLING HITCH ROAD - Health 161 ROLLING HITCH ROAD CENTERVILLE A= 192 - 102 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Certified RberSourcing POST-CONSUMER wwwAprogrem.org SM12M MADE IN USA GET ORGANIZED AT SMEAD,COM 2 No.- � Fps. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . ...........0F...L .!b 1 ( &.... ........................................ w a#i n pr ispnstt1 arks Tonstrnr#inn rrmit App is hereby made Permit to Construct ( ) or Repair (!"ranIndividual Sewage Disposal SystemC�/: w-rg-1 / c tiggni s �N � ?` v 1 Aet No. ........�. ��_.........__ll..... -J--1-. � - .............................. ..[. C)Ll� Owner ` /�ry D e •�- Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....:................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...-----•--------------••------•-------........--------•--•-------------......------------------....................-------•-•............----•_..... W Design Flow............................................gallons 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.............--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.---.................--. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 0 Description of Soil---------------------------------------------------------------------------------------------------------------------------__-_.---•--••--•--------------•----•---•---- x U ---•---•-----------------•----------•----------...---------------------•-----------------•-•••-•------•-....------------•••......-----•-••-•---------------------••-•-•-----•--•••-•--•----......_...... .........................................---------------------------------------------•-------------------------------------•--•--;,1 Nature of Repairs or Alterations—A er when a 1'cable '- - '8-� Agreement: The undersigned agrees to install the aforedescrib�d Individual Sewage Disposal System in accordance with the provisions of iITILj 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 buy the board of health. Signed =�. .......... ................................................. L_/ _j•....-:=-.I I— �./�� f� Application Approved By- .......`;r .��yO'_._.....:... �/ 'E: /-°'--/ . Date Application Disapproved for the following reasons: ----------------- -------------------------------•... ._... ...............................................................•----....-----------------...---------•---------•-----•---------------------........................................................... Date Permit No. -•--- ... V/--------- Issued---•----./� Date wtfi r No......................-- ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...-------- ..............................OF......................................................................................... #lint#i ri�fur, Disposal Works Tonstrur#iun thrmit Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal System at: jZ Lc�ca��F 1 /�/t`1 (Alders r eA �/t 1/ i /�el No. �........................ -- ....................... ..............•-•- Owner Address ------------------------------------------------------------------------••-•---.....•••---•....... ..••---------•••......-----••.............•••.-•--.........-••-•--•-•-••-•..................--•--- Installer Address UType of Building Size Lot............................Sq. feet ,. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers G1 YP g ---------------------------- P ( ) — Cafeteria ( ) 0.1 Other fixtures ------------------------•---•-•• . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------------------ Diameter.................... Depth below inlet.................... Total leaching area.........:........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--.................---- P4 ----•------------------------------------------•----•--------.----------•----•-----•------------------------------------------- -------------------- ... 0 Description of Soil........................................................................................................................................................................ x V .....•••--•••-•-•••.............•-•--•••••--•............................--•--•.....------••--•••---•••--•-••-••-•-•---•......-----•-•------•••......................................................... W ---•------------------------•-------------------•--------------------------------------••-•--------------------------.......---------..........-----••-----•---------•-------------------............... U Nature of Repairs or Alterations—Answer when applicable.b"ZZ-"A7�..,0.✓/<" %2 G. . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 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 the board of health. Signed--- --•---------••• ,- f /� ✓ ' Date. Application Approved By =:�� s:c "= L ' .._ �'/!.__`I.� .� f/__ //_ I K Date Application Disapproved for the following reasons:.................................. ../ ................_.. ......................................................•----•--------•---........-•----...........---•-.................................................................... `� Date Permit No---- - `�' ', --. Issued------....Z/' `i41 - ...................... '. ..._...__..F ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...::..t....... ...............O F........................................:........................................... (Irr#ifiratr of Toutpliattrr THIS IS TO CERTIFY, That-,the Indivi ual Sewage Disposal ;ystem co trusted ( o> Re aired ,( LK - ,.. l ` /3 at•---••--r�• L-' 1\.{ 1 /(� ?� . tInitaller , �f_C•L%•(./ ........ --- • .--• ••. •-----..._.. -i..........1........... •.... ...... . -• . has been installed in`accordan& with the provisions of TITLE 5 of The_State Sanitary Code as described in the r dated application for Disposal Works Construction Permit No.•�<f:.._ �....ef ---.- THE - e ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/ FUNCTION SATISFACTORY. DATE.. ,/` (-(' Ci/�----------•...............•--•......--..... Inspector.................................................................................... 1 THE COMMONWEALTR OF MASSACHUSETTS _ BOARD OF HEALTH, , ,l1. - .........._.(i- ... .. �. ...... '...............OF................ :: .... ` ...........................................``.. . No......:..............:.. r FEE........................ Disposal Works Tuns#ruc#iun rrmit 'Permission is hereby granted.......... !.-,rc.Li•:..........`- -•. ......-•-............-•-•--•-••--•-•-----••-••............... to Construct .( ) or Repair ( j)_-an Individual Sewage Disposal System �l / d street '-3 as shown on the application for disposal Works Construction Permit N'6.................... Dated..................... . . ....... Board of Health DATE.----' ' ................- - FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS //TOWN OF BARNSTABLE LOCATION l (.�[ ��F�/�`v rt� - SEWAGE # 9,2- VILLAGE��.�.�,/I(f/�1� tASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 12 , P, (�ar(L_ SEPTIC TANK CAPACITY 1406L LEACHING FACILITY:(type) � Ga�, (size) e NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWNE (a {fhc �e DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � 2 G c VA �e C Alt"