HomeMy WebLinkAbout0166 HARBOR HILLS ROAD - Health MCf q rr Rr
SMEAD
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE
FORESTRY MIN.RECYCLED
INRIATIVE CONTENT 10%
Certified Fiber Sourcing POST-CONSUMER
vmwsfipropremorp
S"12M
MADE IN USA
GETORGAN9WATM4D M
TOWN OF BARNSTA�1BLE
LOCATION 1 Co6 d{Q�Q� Ifs �(X SEWAGE #
VILLAGE &Ael?a) ASSESSOR'S MAP & LOTd.Q7'0 gg
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY �pig V �G
LEACHING FACILITYAtype) (size) p
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER f0d)C.
BUILDER OR OWNER ��/U/� �S
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: eo
VARIANCE GRANTED: Yes No
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L a ��
l2q- TOC119
No.....2 -------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
06�1 X/ -- --- --------OF....... C.......P
.........................
Apphration for Biiipviial Works Tonstrurtijan Vrrtuft
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System
..................
..... ... . ..... ... ..... -------114.1 . . .
-----L at AJZWrEe or Lo.. 0.
...............,
.............. .......rX........ -V............................. - ----------------------
-L_740. ner ..................Address
.............. .. .. . ............. ......... ........ -------- -------------------------- ......................................................
4 staller Address
Type of Building Size Lot,
U /,&rj,37------Sq. feet
Dwelling—No. of Bedrooms------2 .._________________________Expansion Attic Garbage Grinder
04 Other—Type of Building No. of persons--------- Showers Cafeteria
P4 Other fixLuregs
------- ---------_--------- .......................... .........................................................................................
Design Flow.............A ._0..................gallons er person per day. Total daily flow__.______._-3...._.___.__._.___gallons.
..................gallons.
9 Septic 'rank—Liquid capacity............gallons Length________________ Width----------------- Diameter________________ Depth-_____-______..-
Disposal Trench—No_-------------------- Width_____._.__.__.__.___ Total Length------------ Total leaching area--------------------sq. f t.
Seepage Pit No.---.I-(W... Diameter____________________ Depth below inlet------- --------- Total leaching area__3.&_-0-----sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
P-4 Percolation Test Results Performed by.......................................................................... Date---------------------------------------
6.4
Test Pit No. 1................minutesperinch Depth of Test Pit____________________ Depth to ground water-_________________--_._.
Test Pit No. 2................minutgs per inch Depth of Test Pit..__._..__._______._ Depth to ground water....___..______.____.__.
..........
0, Description of Soil--------------------------- - -------�4 -----------------------------------------------------------------------------------------------------------------
—15 _�a_-------------------------------------------------------------------------------------------------------------------
U ..............................................................................................................................................................-------------------------------------------
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U
:Vl 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 X1 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the boar -healt
Signed--- r7 P
Pate
ApplicationApproved �y.............. .. .................................................... ...........
Date
Application Disapproved for the following reasons:..................................................................................................................
........................................................................................................................................................... --------------------------------------------
Date
Permit No......................................................... Issued....... .....t�X/_Z---3............
Date
---------------------—---------—------- -----------------
No..... ------------ F E'lic... %:..,�: 1........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.
•+N r
AVV iraflou for Disposal Murky Cnonstrurtiott 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at fi
.....__....... f -. --- .4r � `-f-;'a�'":.r
Location or
Address .' /
- / Lots o
s �w
___! � t l--- 1.._l. ............................. j
Owner Address
a _ ---------------------
Installer Address
UType of Building Size Lot;%>' rHPZ_._.___Sq. feet
Dwelling—No. of Bedrooms____ ... ----------------Expansion Attic ( ) Garbage Grinder
r
a Other—Type of Building ? +fy$� No. of persons........_/............... Showers ( ) — Cafeteria ( )
Other ..01 -fixtures ----------f--------------------------------------•----------------•--•--•-----•----------------------------•-.--•--------------
W Design Flow............ .... ..................gallons er person per day. Total daily flow......_.....
t __._..____.__..__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----�_I t_ •.. Diameter.................... Depth below inlet....... Total leaching area-_�0:, I....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date------------------------------------
M Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_--_-_--_-___-_--_-
(q Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water-_--_______--_-_-._---.
1 y
D 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beer,issued by the board of heath
A. S14—
igned F r tK t x t = ----------- - "
Date
Application Approved BY 1_1 s": ....- •-------••--. -----------3 -•'---- ,-
Date
Application Disapproved for the following reasons_________________
............................-------------------------------------------------------------------------------------------------------------------------------------------------------------- ..............
Date
PermitNo......................................................... Issued---------------------- ----•---•••---•-----....---•--•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Q'I rdif iratr of Toutphatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
byo -.e„
Installer
at-•••-•••--• '¢. �t'_/Y� -•-'� •-•-4..... f r� rya•ed='.`.____..--- "d�-6'r.,f'_ ''-----•--•t i-'-'-•{,'------ r _''d--- -----------•---•--------------------•--------
has been installed in accordance with the provisions of Article of Th.O/State Sanitary Code as described in the
application for Disposal Works Construction Permit No........_ ----------•--
............ dated....__ e_.... ;..__?__
C , __________________
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector---------------------------------------------- .....................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
}ww
rb
No...... ................ FEI_�aZ._.
Permission is hereby granted.............. ... . "y= ��-----
to Construct .(, ) or Repair ( ) an Individual Sewage Disposal System
at No...........t.`T ' - �aE_.r i r ,s., s_ t 1 '." t f4'r e� i
Street
-•• .
as shown on
-then for Disposal Works Construction Permit _ _� � ated---:�._:__' __� �:�..............
Board of Health
DATE --------------•---.
FORM 1255 INC.. PUBLISHERS