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Home My WebLink About0223 ROLLING HITCH ROAD - Health (2) ��J�� 1�5 FEB...No........ �� ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® O HEALTH i �� ......OF......... ?... . ..:............................ Appliration for UiipuiFal Workii (famitrurtion ramit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal Wst ar. -. dr �1 L ca' Addr /y` O� Address Installer Address . .. dType of Buildin Size Lot__/ dd__:-�_..Sq. feet DwellingTo. of Bedroom ___________________Expansion Attic ( ) Garbage Grinder 04 Other—Type of Building :_. _____ � No. of persons____________________________ Showers ( ) — Cafeteria ( ) aOther fixtures ....................................- •-----------------------------------•--.---- ------•------------t!5�---•------- ---------•---- W Design Flow..................___..........gallons per person per day. Total daily flow.......... . ___ ............:gallons. WSeptic Tank-1 Liquid capacityl'000_gallons Length................ Width................. Diameter................ Depth................ x Disposal Trench—No_____________________ Width_._._ ._.._._______ Total Length.................... Total leaching area.................... ft 11 Seepage Pit No.....).............. Diameter._ .. -__ Depth below LLinlet_________ _____.._ Total leaching area__ sq.�fftt. Z Other Distribution box ( ) Dosin�jta (L) �,p� / 7- iy--7 �3 7b '~ Percolation Test Results Performed by..F�.. 1 •.-----------•------• -=- -- Date___ ____ZY______ _ _____________- aa Test Pit No. 1_--C'------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------_................. w r_.._... ..................•--..._._. ,., p J Description of Soil ...... f,�-a=----- . _lpr ?s�. _U- !� =------°�'---r---- •---f-=' �-fl.e�.� '- ...-----Z' -----•----- W .... -----------------------------------------------------------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 iITI.:. 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. Date v Application Approved By......- -•-- f-- •• �%�r/�o�l V Date Application Disapproved for the following reasons--------------------------•------------------------------------•---------------•-----------------------•-------•- :... ------` Date Permit No................................••------•••-_•••- .l3 �� Issued f Date No................ - ... FlcE THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH # I ......oF......... ............................ 3 ,. £' t Applirafiln for Iliqpniia1 Workii Toutitrurtion Vrrmit V I s Applicationi is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal r ; S St at L c Addr -or I of No. .......................................... ................................................. ' -- ,., 1 .;.,.w, +• Address -........ �- •---- ----- '=�-----------•-•--------•--- --------•••-------•-------••......................•----•-•.... .__..... •---•----•--•- Installer Address .eiM Type of Buildin Size Lot._ '-"' Sq. feet -• o. of Bedroom _____ _________________________Ex Expansion Attic Garbage Grinder M - Dwelling . . p y ( ) g ( . p`�,"` Other—Type of Building : '._.:.' No. of persons__ ________________________ Showers ( ) — Cafeteria ( ) ILI Other fixtures --- ----------------------- -------------------•---- Desi n Flow_________________ allons er erson er da Total dail flow_______ W g ; g P P . P Y Y -----------------melons. WSeptic Tank-t Liquid capacttyl.lQd-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 leach• g area._. '�_.sq. ft. 4 rfg Z Other Distribution box ( ) Dosinta,�k (�. ) �� i l , y ' '~ Percolation Test Results Performed by._ _._____._. / ________________(A____ �! _______ Date...7.. Y..._ ............. a Test Pit No. 1. ; :-_.__.minutes per inch Depth of Test Pit____________________ Depth to ground water....................... fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----__...______..__.___- W ......... • Description of Soil---�`------ --/�l/---- ---- � p :.1!�..��,�� ........................ ------------ ........ ............................ -U _ --------------------------------------------...............I, W b.----r. UNature 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 iITIL 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.. Si d -------••• •-- t . - Application Approved By........ --- .....yi..... .... Da` Date ...._._._ Application Disapproved for the f olloiving reasons=------------- ,,•, ;.- ------ ------,-----------------------•---------------• -----------------------------------•-•------------------------------------•--•----------------•-----------••--•••---•---------------------------------------------------------------------------------- Date PermitNo. =- ••------.....•---••-•--• Issued..................-.................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH . ..OF..... .... .......... ....... ........-...... ........'. ., Tatifirab, of Tons, rr1� � TH IS T CERTIFY, That the Individual,Sewlge DisposaItSyste ,,-,&}�ons hl; d F( r 1615 .« of #•- ,. ,�f 7 I � �ta „a W a..t'zo._r by ° •.- it" t l( 'r has been instal - - ....................................: t -- .: ' 1. •a. r f The State Sanitary Co as;es b in the 1 in"accordance with the provisions"of T -' ` - application for Disposal Works Construction Permit No....- - _..___ ...................... dated_- ---- -----------------------_----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. a ( DATE----------------••_-•• ..: . ..:.. - InspectorJ 3 THE COMMONWEALTH.OF MASSACHUSETTS BOARD F HEALT .............. No...._....J... FEE ......... ........... Mops"' I or � WC jtr�rtilait trout Permission • reby graned--••=- • ------•. •-- •----• ---•- to Const or R i an I ivldu`al v e�j o ��n t at No.•-- • .- ------ ..__ . ------ - • _•__-•' Street as shown on the a ication for Disposal Works Construction Permi f._`��__ ted___. _*_ � �` .............. .140 .. Board of.,Health DATE... FORM 1255 HOBBS & WARREN, INC:' .PUBLISHERS - - - S1UiGLT-:- tL.�4 ►.lO GAres�e C rL1 1r o 110 - 3 : S-40 G•RU• �EPrtc T+a+-1k = 330.. (SG % • S 6.P1D. Q a • F�.'y, _ USA- l CUUC� GAL i t p� it t l.�SE- I o0o GrA.t_ ` r . ISPoSAI. P1T U , .l174</AL.L AZE.A - (SD S.P. Q/ SD Sri. .� l .o - 6U c�.RD. ' FV` ` AMP ToT'AL 'C7ESIGIJ - U PST -FDTA L `+ 1N 2_MIW 'O.Iz • �i1GDLQT101.1 SZATE : J ZH OF R1 t t `4f T : IC HA Ln r 9.0 Tap F.+o s goo 0 TI jT 9 ` q7..ov b c rf Q rpPe I Ooo I►N qL 70 < t 1 { x S. ' Sd8 so,t 4rpPEs D 1► . 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