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Home My WebLink About0041 ROLLING HITCH ROAD - Health (2) qj Q�(j Fins............._............ _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH f�l ....--• .:...... ........................OF...............................---._...........--------........---....__..._............_. Appliratiun for Diupuual Works Tomitrur#inn rantit Application is hereby made for a Permit to Construct (()_ or Repair ( ) an Individual Sewage Disposal Sy at: W........... o.ati Add ss ......... � � - �" .�.fl !_�'. ............. caner � Address . 1.....:..... l ------------------------------------ ----- q ........................................ A.6._u-5---•--- Installer Address U Type of Building Size Lot..... Z �__/ :.Sq. feet Dwelling—No. of Bedrooms............ ___________________________Expansion Attic ( ) Garbage Grinder ( )/ PO- aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ______ __ _____ W Design Flo 'S___ _______________gallons per person per day. Total daily flow..........334_....................gallons. WSeptic Tank—Liquid capacity/.90_0_gallons Length................ Width---------------- Diameter---_.._.__.._...`Depth................ x Disposal Trench No......... _____ Width.................... Total Length__.___.__...___._.. Total leaching area....................sq. ft. Seepage Pit No...........I........ Diameter._._.__......... Depth below inlet___-.�e__________. Total leaching area_o.2 A .....sq. ft. Z Other Distribution box (✓) Dosing tank ) ""I' � -- . - 1 � - ?A � Percolation Test Results Performed by.............. .�.. _�.r-...a��___.n�__Q.,::;'::._:Date__._._._.___.__._ ________._..__.___ ,.a Test Pit No. 1.1._l!�---A__minutes per inch Depth of Test Pit___________ ____ epth to ground water;.....h O.•-.W(L f' Test Pit No. 2................minutes per inch DeptV of Test Pit.................... Depth to�ground<water_.......... -----•----�--------•--•-•••-•-•D-•-•-----•-------•__________________ •-----• ------ •----_....................-----• ......... Description of Soil.......0_7-21--•-•-------------- -_...A!'!'1...,._°-.......6.45.�1_SQ-Li.----j - - /02-------._�ecA......._ .Q.-•--- V ------------------------ -Q g..1`S.G... All,a..... -------•-• •--------------------------------•-•------.....-------- W ----••-----------------------------------------------------------------------------------------------------------•---••------••••-,------------••-•••------•-----------•------ ........................ U 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 ITLL 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in 7pAplicati tion til Certificate of Compliance has been iss the board of health. Signed D e n Approved B = ��,...... .............. .._.......___................_- Date Application Disapproved for the following reasons______________ .. -------------- --•-----••-••--___. = :: :. Date Permit No._...`?.� . '..: ............... Issued_.................. ---------------- Date si No. .: .: FBa...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................:.......................OF.......................................................................................... Appliration for Disposal Works Tonstrurtion rrrmit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at .... o.11.,:a' ., �:.��:l:�i= ..Q� :., .C '•................... ..... ....4.1........ -----........`?�1............._. 9 location,.Address or No. .......�' __..CY1c.19.1. ,.�.� ._...-•---•--- �O....Sc! � r..... A .... .............. 1�. .... ...._._...---- Owner Address a --••••..Ca t.]....... ................................................. ...... dd.r n.t Installer T Address Type of Building Size Lot..... 17,�.q 8.8....Sq. feet Dwelling—No. of Bedrooms........3.........:....................Expansion Attic ( ) Garbage. Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) - Cafeteria ( ) 04 Other fixtures --------•---------------------------•-----•--- W Design Flow S.....................:..................gallons per person per day. Total daily flow............ .��.. :"______.......__........gallons. WSeptic Tank—Liquid capacityl..� Q.gallons Length.....:::........ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area..............--...sq. ft. 3 Seepage Pit No.._.._.__._d._._.... Diameter........ Depth below inlet......�e?........... Total leaching area............_....sq. ft. z Other Distribution box Dosing tank I ) '~ Percolation Test Results Performed by.............1:.�-?�. �.I ....G!2 ..f. ...Q........ Date...._�..- �.9.... ----------- Test a Pit No. 1.�...t!f...ol.minutes per inch Depth of Test Pit.......f......... epth to ground water..10..�!!.k ke.r Lt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... a -------------------------•--------......------....---------------•------•-------------------................-•---••....•--•- D Description of Soil.......6.......1.................L o �, n� � S c,� <g, � 7 _/,Z ' / i ...------ •-- •-•••-.-. -1--.... >:................ .......... C , v .........---••--------------1?.._ .!:.:f.e:- ........ ?. n..� ...... W U Nature.of Repairs or Alterations—Answer when applicable................................................•........................._.................... A,, -•---•--•-••...................••----..............------.....-•----.............---••--•--------•----•-•-•--••---------------•----•--.........-----........------•------------------•--•-----•.....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in op tion t'I tertificate of ompliance has been issued by the board of health. Signed...................................................................................... ..._ _ D e ppI cati n Approved B ............... A fi.,,.�^�.......................................................... ........... - Date Application Disapproved for the following reasons:..........................................................................................................___ --•-•....................................................•------•---•---•-----.........------•-•-----•--•'-----•-------........----•-------------.......---------------.........•----........._.....--- Date - Permit No..... ' =e.:' ......_ Issued........................................................ Date 4 r, THE COMMONWEALTH OF MASSACHUSETTS lip �4v 4 BOARD OF HEALTH ................................. ..OF............................................................... ............. Trrtif utttr of ToutphUt rr THIS I JOXERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .......�n: .......................................... . :.. .........:........... ........ ..........--•---................._...._..... a�. In ta has been installed in accordance with the prl of TITLE 5 of The State Sanitary Code al de cribed in the '1 application for Disposal Works Construction Permit No._....�G -y_'..'�7 ... dated.............. 60.4K............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUA�ANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE.................•- .....-�$.... ........................... Inspector................ - .: . ......:. V THE COMMONWEALTH OF MASSACHU TTS BOARD OF HEALTH No...g.. . 1"7;0, ...........................................OF............---.................---.....------....................................... FEE. ..--'... ?:� .... Diopaaott arks onstrurtion f rrmit Permission is hereby granted.........- - •-f fE . 1................................................................................ ___.. to Construct ( ) or Repair ( ) n Individual Sew g Dig oral System at No..........>t- ► --..f�.j.. !'.V1..• - PM&I, --�' =�- ... �t� .................••...... ............. Street as shown on the application for Disposal Works Construction Permit Nq .....�Dated....._... ........... Board of Health DATE.............. F' L FORM 1255 A. M. SULKIN, INC.. BOSTON DES/G/V 0�17`Q I I ETD -- - IVO (5.4 2B.4GE OA/L Y F-40 14/ - //D X 3 r 3049 0 J SEPT/C 7 4N/f = 330X/Soo -5�9�G.PL7 v�/.j v ; 4. r`/•Gr•. 3/ .r • V, rp � ti ,fo s,� e i a = ,s-o G..�a. t�� o 7-o T•4,C r8� �N �L �G / 0 TOTAL_ � QE,S/G�t/ �E.2COL•QT/a�V.2�1TF' .< /,V 2 �'/N. O� GE.SS 97.E f� RICH SUttfV.AN j a SAXTER No.29733 No.2 048 �Ql .FEr rSTFF'ST TEST'f,�a�.E _ ._.. .. -;._•--_. -,97-7 .., A/ 9%o Sig_ ( f<" pisT. ''•' /,vop /N✓. 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