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Home My WebLink About0170 HARBOR HILLS ROAD - Health 170 Harbor Hill Road Centerville A= 227 - 101 �lll J�QE�ctro� UPC 12534 No. 253LOR � 1 �PosT.CONS�� i HASTINGS, MN No..... ......... I Q THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �wSTd -- I�� , ppli.ration for Mipooal Worko Towitrurtion Vrr it u! Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage ispo 11 —� System / ... 1 _.. r . r' ocati Address or Lot No. ....................... ... . . ..... ...........a....................... ..................... ................ Owner �en / Address W ..... � Installer Address Type of Building Size Lot.. .� _'�f._J.......Sq. feet Dwelling—No. of BedroomP�4 ..............Expansion A tic ( ) Garbage Grinder ( ) aOther—Type of Buildingo. of persons--------- Showers ( ) — Cafeteria ( ) Pa Other fixt s -----•----•-•---•-----------------•--------•----------•---.---- W Design Flow.....................�--_--__-----____gallons per person per day. Total daily flow........ `.._ .:...................gallons. 04 Septic Tank—Liquid capacity------------gallons Length------_-------- Width---------------. Diameter---------------- Depth_____________- W 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 ( ) aPercolation Test Results ll Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water__________________._-__. �Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. P4 --------- --------------- ----------------------- •-------------------------------- ------------------------------------------------------ ---------- 0 Description of Soil-------------------- ....................................................-------------------------------------------------------------------- x U '-•---•-•--'-••--•-•--•-----•------------•-------------------------'---'-"'•-"•"••--'--'-'-'-----------'----'-'-'-'---•--------------------•-"-••-------------------------------------------------- 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 Article XI 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 board o th. Signed---- -- ---------- --- -- - - . =1<. Application Approved BYd�: = ��'-c------ --......................................................... ---------�- ----------------- Date Application Disapproved for the following reasons:----••------------------------•----------------------•-----------------------...----------------••--•-•-........ --------------•-•-------•----------------------------------•----••------------------......---------------I----------------------------------------------------------------------------------------------- �Date Permit No. �------------------------- '----------------. Issued. *X � ', Date L •G` G--� THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH . OF. Appliration for Diipooal Works C�o�t ur ioo Crroti Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• • ...._-- �S�' f ,��Tv�'j:--- ✓�Y...--.:.^6. j`� �1'X i -_-• ---------- Location Address r or L o ot N ,/ Ft ? w Owner , A$�res�s a ........................... Installer Address UType of Building Size Lot_, /. _-7- _._.Sq. feet Dwelling—No. of Bedrooms_____________------------------------------Expansion Attic ( ) GIbage Grinder ( ) ar•A4�' a Other fixtures ___Other—Type of Building f�� Y ., No. of persons ______________ Showers ( ) = Cafeteria ( ) � . ::_ _: - •--------------------------------•------•-----------•---•----••-•--� ------------- �,, ' w Design Flow______________ ____ ___...............-gallons per person per day. Total daily flow........_%�� _-__-__-__-___gallons. `) WSeptic Tank—Liquid capacity------------gallons Length................ Width--------------.. Diameter__.-_-___-- Depth.-..-__--.--_-- xDisposal Trench—No_____________________ Width..................... Total Length------------_----- Total leaching area....................sq. ft. 3 Seepage Pit No._�_ Cf?VV_ +___ Diameter____________________ Depth below inlet_____._________ Total leaching area_ e, �-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results' Performed by.......................................................................... Date_------------------..................... 4 Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water..-___--__-__________--. rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_---__--_-______..-_.--. (x ;;�;�---------------------------------------------------------------------------_-_------------ ... D Description of Soil----------------------!� ft, ' -------------- x 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 bee: issued by the board of health. 9•- .Fr ✓ Py, �t,✓> rt r�DateC -------- --••.......................................................... ------------------- APPlication APProved Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------------------- .--------••---•-----------------------------••-...--------•----•---••--•------------••------------'---•---•---••--••••••-••••••-- -••--•-------------------------------------------------------- 0 Date PermitNo......................................................... Issued-------------------------------------------------••---• Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF� HEALTH 1 � ..........................................OF................................................................... Tatif iratr of Tomplittorr THIS Jh �01C•ERTIFY P•lael,& Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ti^ J f le +x { - lCr `r',, jr ° J f at.............. -------------_-- -----•--•---•---•---•........................................................................................ --------------------------------------------------- has been installed in accordance with the provisions of ArtWe I of The State Sanitary Code as,desc • " in the application for Disposal Works Construction Permit No......................................... dated_..__: ____ ................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTIO SATISFACTORY. , -- ? -•--••.................••-• Inspecto DATE------- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 UV No....--••••••-•••---__-••- FEE......................... i� o ,ro Cnu,,o�o �criog� rri Permissionis hereby granted----••---------------------•-•--•----•--•-•---•-•---.....•---••------------••••--••----------r---•-•-•----s ....-----•••••--••••••__•••••- to Construct; - ) or Re tr ( )fan�Zndlxidual Sewa el Ispos 1,System {��,%fs ;; ✓r=j at No.............. 7 ... Street v ! f as shown on the application fo Disposal Works Construction. Permit N' " _F� __-_.__. ated-__ _.___..f`__.___'_'_..__-- --------------- ---------------------------------•-- Board ealth DATE = - - ----- ---- ------ o ----------------_------------ FORM 1255..H0 SS W RREN• INC.. PUBLISHERS ,