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Home My WebLink About0172 HARBOR HILLS ROAD - Health /// SMEADR KEEPING YOU ORGANIZED No. 12534 2-153LOR SU AIN LEMIN.RECYCLED INWIVE CONTENT10% Cer fiedFiiberSourcing POST-CONSUMERg,P www.swpmgremorg S olm MADE W USA GET ORGANIZED AT SMEAD.COM 36 No.. ........ Fizz_ .O................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ....... .. - Apli iratiau -fur Uiopoiial Works Tuuitrurtiuu Vrrutit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at Locatio ddress or Lot No. W / Otyner Address Installer Address UType of Bu_ ding ,Size Lot./. ------Sq. feet Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder (Xr� aOther —Type of Building ..�3--------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ----------------------------------------------------- w Design Flow......_,f�r�---__--_- _-----____gallonsvper person per day. Total daily flow--------------------------------------------gallons, WSeptic Tank—Liquid capacitv_AU ggallons Length---------------- Width................ Diameter---------------- Depth....-_-__.----- x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No., Ur�o_ y�Diameter____________________ Depth beW nlet_......_ ._..._.___. Total leaching area____---.-_._-.--_-scl. ft. z Other Distribution box ( ) Dosing tank ( ) /�� /L- &/ -2 -I-l G aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-.----.----------------------_.-..-..... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-.._.----_-_--____-. Depth to ground water...._-_..___.._.-----.-. f14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ P4 '-----..... -- -- - ----------------------------- - - ------------------ -- x Description ofr�of _ 7'--0•.n- -' " 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued y the board f health. tned ---- - ------- •----=-• --- - --- - •- --- --•-•-.....--•---••-•--••..--•-- A Application Approved B Date PP PP Y ._....... -- - -- I ----g P � "- Date Application Disapproved for the following reasons----------------------------------------- ---------------------------------------------------------------------- Date PermitNo......................................................... Issued.......................----............................. Date *;:q4 LOCATION_ SEWAGE PERMIT NO. -36 -2 , l IfL A G E INSTA LLER'S NAME. & ADDRESS j B U I'L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _� ,., ,� ,�' ;� �1 `� � _ _. r No .3 Fss... .. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD /O=F HEALTH .............V_eWVL.OF..........I,1.V....4 Z 1 ....A......... Appliration -for Biipuiittl Works Tonstrnrtion Vantit r Application is hereby made for a Permit to Construct ( /0)"'or Repair ( ) an Individual Sewage Disposal System at .— .location--Address or Lot No. Ovvner Address Installer Address d Type of Building Size Lot._/_ -----Sq. feet Dwelling,—No. of Bedrooms.;__�.................................Expansion Attic ( ) Garbage Grinder (AJ y p, Other—Type of Building ... ................. No. of persons---------------------------- Showers (,;J) — Cafeteria ( ) Other fixtures ____________________________ _ W Design Flow--------- .........................gallons per person per day. Total daily flow.-------------------------------------------gallons. WSeptic Tank—Liquid capacity_e�' gallons Length------------_- Width................ Diameter................ Depth..-_-_______--- x Disposal Trench—No-____________________ Width-------------------- Total Length___________.-----_ Total leaching area..-----------_.....sq. ft. Seepage Pit No..� -_'_)._'c_,,*`Diameter-------------------- Depth below inlet___________________ Total leaching area__-___._______-___sq. ft. z Other Distribution box ( ) Dosing tank ( ) dj� �C _ .2 ./- 7 aPercolation Test Results Performed bY........................................................................... Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water--------............. ... fZA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__._..________.___-..-.- O Description of Soil _. 0..:�/r_. i �C._J.�/�_.! --!.__:.v��p.'__. J x _ ---- x ------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bythe boar of health. Signed._r � l�r-; /�J Date Application Approved BY " G %y(,`:..-.-t_., .yl ... ... � Date Application Disapproved for the following reasons:........................................{_ -....................................... .......------- I .....----•----------------------•----•-----------------------------_...._..------•------------••-••------I--------------------------_-_-------------•-----•-•-----------------•--•----------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Q HEALTH ....... ....1... ..........OF.........1V�l-�- �...:............. Trnif iratr of TomViianrr THIS I. TO CE T PY, That the Jndividual Sewage Disposal System constructed (/-/) or Repaired ( ) by........... ----------------------- -- z. ----.--..... ns ller J at_ W-44��--. d---1r has been installed in accordance with the provisions of Arti 'i'RIT of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._-`__�--___-__J�e ...... dated_._.s_: 1--Z---7_G................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE.------...2V `'�C� �� -------•.. Inspector------ --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/IHEALTH No. _ ............. .. .... !1.......0 F...........iw ........................................... � y FEE--•--------'= Di:vo 'l ork_q Qla itrurtion rrrmit Permission is herebyranted.______ '►-'L??._ � - s_! - r •. ---•-• -----------------------------------------------------•---.--... g s- i to Constrq t�( �or. Repair ) an Individual .SewQe Disposal System at No.---- 'tea .... ........... cC.l..,/rJ1 _/ _ u "- r .,• ...-'-•-'-----'`'Street y-•-•--••------------•--••-------••-----•--•--------- as shown on the application for Disposal Works Construction Permit No.r__l__r___.... Dated__<<C------._!�i. .......... r Board of Health /j DATE-------------------------------------------------------------------------------- FORM '1255 HOBBS & WARREN, INC.. PUBLISHERS �� j Sz- k" 17, 520 I r � `-OF RICHARD ( $ BAX7ER �3 t Na 24M Sys SON C &K {C►fitDN • COA16VIL-L& N1��i5 LOT eE,2ri)C,f rAl r' �7"Af� F0aN40 ridA �AK T� s QqE ' c , Wti1 l� V&0 CG � S o TIC � x �[ tla►.�°La �vrz�16#� .3� cIST CS GAAA�Se> - -Pei I Tt a 0 gz.:. eo �77AQt.Jtt+.5,