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Home My WebLink About0019 FOX HOLLOW LANE - Health `� fox rollo�J law— , OsVexvilce, Pi = 14�-00� -C)c) _ 1 6p 'a TffN OF BAR STABLE✓ J 6�jp �� 1 i� 7 LOCATION SEWAGE VILLAGE . AS ESSOR' MAP 6t LOTA�'—(e INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 49, NO. OF BEDROOMS r PRIVATE WELL OR PUBLIC .WATER ` /k4m BUILDER OR OWNER DATE PERMIT ISSUED: &-2o DATE COMPLIANCE ISSUED: ,I VARIANCE GRANTED: Yes No 4---- . ,r } � r 12.. /it F� ....T�..•................ �...�.. .....-- .- �` THE COMMONWEALTH OF MASSACHUSETTS BOA F HEALTH v ....-....--.oF.-... .................................... Appliration for Disposal Works Tons1rurtinu Frrutit Application is hereby made for a Permit to Construct (L,or Repair ( ) an Individual Sewage Disposal System at: �n- ddre.s or t No. LS�iaSs�------------------ --------• LZ.. !.�.�i Qom.....-. ! ..__.. r� Aowi d ess--------------- •- k=. ---------------------------------- -- ... a~ ' sta er Add ess VType of Building 3 Size Lot_. S,`�7C�______-Sq. feet U Dwelling—No. of Bedro ________________Expansion Attic ( ) Garbage Grinder (�) Other—Type of Building _ �� !3�_ No. of persons____________________________ Showers ( ) — Cafeteria ( ) a' Other fixtures ...-•-•-••-•-••--•------•---•--- - W Design Flow...................... V............... per person per day. Total daily flow--------- ...................gallons. WSeptic Tank—Liquid capacity ZOVI2.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........................................ W Test Pit No. 1................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........................ a ------------------------------------------------------------•-••••----------•------••--•---------------------------------- •-------- ---------- ---•------------ 0 Description of Soil....................................................................................................................................................................... x U ••••--••------------------••••-----•-...---•------------•--•-•-----------•--•-•--•••----•-----•-......._---••-•-•---•-------•--------••---•-•---•-•--•---------•••••--•---•-------...._..--------••-••- W 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 'T I:,,L_� '• 5 of the State Sanitary Code—The undersigned furthe agrees ot, }�¢g the system in operation until a Certificate of CompliacrEe as sued b of health. `�iGlsu�.Ce`. f - Si - - --------................------• ........................ •- Date Application Approved By................... .....................-=:................... -•••+� Date Application Disapproved for the following reasons:-----------------------•------•--------------------•--------•--------------------- ........................... ..-•-•••----•-•-•---•--••-•--•--•-•----•..-.-•---------------•------•------------------------•---------- -•--•-•---•--•--•-•--•-•-•--•••------------•----------•----------•••••----- -------------- Date PermitNO.- ...... Issued....................................................... Date ri f-2 4 ................ FIZZ .....-......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH / ------.../ .............OF..... .-.-_'...................................... Appliration for Disposal Works Tonotrn.rtinn ramit Application is hereby made for a Permit to Construct ([nor Repair ( ) an Individual Sewage Disposal System at: ....----- L�i _�......�x4lLo-.__ fQ:�..---- ...... ............� � ... eon-`Address or -t No................... j{----.e........•;1_ .......... v Own r Odress � fist !er � Ad Tess UType of Building 7� •�Size Lot.� ,±7 ............Sq. feet Dwelling—No. of Bedroomst ..........................................Expansion Attic ( ) Garbage Grinder (iuo) P4 Other—Type of Building _!r a .. No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ........................:................................................................................................. w Design Flow............................................gallons per person per day. Total daily flow-------- ....................gallons. WSeptic Tank—Liquid capacityl.P,00..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 ( ) .41 aPercolation Test Results Performed by.......................................................................... Date........................................ 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........................ a --•••-•--•--•-•-•---••-••-••-•...---••-.....••-•-•----------•-•....•------------•------------------ ------------------------------------------------•-------- 0 Description of Soil........................................................................................................................................................................ x U -•••••-•--•--•--•-•••••-•--••-------•-------•-------•..........................................••••.......--•-------•-••--•-•--•.....•------•••---•--•----•--------........-------------•--....---•--... w VNature 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 TT E `}of the State Sanitary Code—The undersigned furtl:e� agrees o the s s em in operation until a Certificate of Complia ce a� n issued b e of health. �! � Date Application Approved BY == y .... = ---------------------•----- -/. Date Application Disapproved for the following reasons:---•---•-------------•----------------------------------------•----------------------------------------------- ----------•--•-•--••...•----•-•----•------••---•••-•-•-••----------••-••.....................•-----....•.----------------•-------......----------••---•---•--•-------•------••-•----••-•••-----...._.._. _ Date Permit No. ......! - ---' Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1L>0!Q.?� ............�OF............ �liz►�IS.l. 41?. .t--.................................. Trrfifiratr of TuanpliFanrr THI V�TOI CERTIFY, T a the I-dividual Sewage Disposal System constructed (b') or Repaired ( ) b .............. �C./� � ---•--. r Installer - at•-.............J_�1......•�............................ `-.J----------L----n------•-� --�=-----------------•----------------------------------- has been installed in accordance with the provisions of T'lTI 5)..of The Stale Sanitary Code as described in the application for Disposal Works Construction Permit No--------- �------ dated---..II/-Z_ .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION. SATISFACTORY. DATE..................hn11 .SL................................. Inspector...............- -2 COMMONWEALTH OF MASSACHUSETTS BOARD_OF_ HEALTH No......................... FEE........................ Rap Agrkii Tnns#rndion amit Permission is hereby granted c_ i l - . -•S. -• .......................................................... to Construct ( ) or Repal at Individual Se age Disposal stem at No...1-'<�.. .. `+F�u'?� l.- ..::_'C ..................................................... Street as shown on the application for Disposal Works Construction Permit N�a.1�25Y Dated.._�� :��?�--�_5............. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - DES IC— f DP�Tfa �= --�- SING-LE FAMILY 3 PCDtZ.ant`1 No GA?,Z A GEDAIL-Y FLaW = Ito x 3 = 33o CG.P D. i �PTI C TAN►G. = 3 3 c� n (So f°o • 4�S �.P• l� USE %000 GAL. TAK Y, QR!Sizvgy, LPIT P OtSPoSAL PST vSE C�� +000 GAL. � ' 3 SI OEwALL AREA y Igo S, 3 7-5' Cr P. 0. { o TaN Y- . 136-rroM A9-EA = 56 S.ir, 8 44.3 50 S.F. x t, o S'c� G, P, D. rs` TOTAL- 4.25' G, P. O. TTT/AL CAILV Flow/ = 33O G-. P. 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