HomeMy WebLinkAbout0175 HARBOR HILLS ROAD - Health I7S Hc,rbor N ;ris �J
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No. 12534
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INITIATIVE CONTENTIO°1'o l
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No..... .7 Fsn.: .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- --- -- -P.40.�.........-0F......�� h.C..E
Applira#iuu for Dispas t Works Tuuutrurtiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
'�- ---......... �1 - � .................
a or
A res d. ....... ' .......... ......
Own
----•-•-••-•---. . ......... . .....----4 C4........ -----••-•
.......-------•-----••-•--•-------•-----•-------------------------------.._..-----------
Installer Address
d Type of Building Size Lot./(9_.f9."ej--7._._.Sq. feet
U Dwelling—No. of Bedrooms .........�..........................Expansion Attic
( ) Garbage Grinder ( )
P4 Other—Type of Building - No. of persons_____________ _-___-____ Showers ( ) — Cafeteria ( )
Q' Other fixtwes ..... .............. ....................
........
W Design Flow............ __ ___ ________________gallons per person per day. Total daily flow..._......J.(� ------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth___.___--_-._---
x Disposal Trench—No..................... Width-------------------- Total Length__._._...._. Total leaching area................ sq. ft.
Seepage Pit Diameter____________________ Depth below inlet........_.._... Total leaching area___-{�asq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------------------------------------
aTest Pit No. 1................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........................
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by the board of h 11
e �
Signed...... ------ -.lt 72
/ Date
Application Approved B -- G' - = Date 7
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
--•-•---•-------•----• ---------------------•-------•---•--------•--•--------•---••-••-••-----•-----•-----•----------------------------------------------------------------------------------------
Date
PermitNo...7. ...:--------------------•----------- ------ Issued........................................................
Date
TOWN OF BARNSTABLE
LOCATION 7 lf e? f-JW,1,5 ebSEWAGE #
VILLAGE AW l 1 ASSESSOR'S MAP & LOT4,� �
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /egoo C),-a t
LEACHING FACILITY:(tVpe) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER � +,� �
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No. 7
.............
.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... .. .......... .................OF.... .....................................................................
Appliration for Dioposal Varkii Taustrurtion Prrmit
Application is. hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at 4
-4�.................
............7 ------ ........
Location-V
or Lot N".
Z;. . .............Ze::f,......... ....----------------------- .....................
Owno res;
.. ...... ...... ....... --------------------..........
a ............... IAZ ..... ....................................................................
Installer Address
Type of Building Size Lot.
U (-------Sq. feet
Dwelling No. of Bedrooms_-_ _,,;--_--------_--_------Expansion Attic Ga�rbage Grinder
14 1
�14 Other—Type of Building No of persons."_._......_,* :.__________* Showers Cafeteria
-
Other fixtil-r-Ts ------------------------------- .............
r
Design Flow..................Q-LI) ..__...._.gallons person per day. Total daily flow........... - ._-_____.-.-------gallons.
W te_r----------------------------------------------------- -------------------------------------------
9 Septic Tank—Liquid capacity............gallons Length................ Width_..__......-.._ Diameter.-_"--___-:___ Depth_".-____--_._.
x Disposal Trench—No. .................... Width.__..............__. Total Length.......__._.--...... Total leaching area--------------------sq. f t.
Seepage Pit ... Diameter-------------------- Depth below inlet----___ ........ Total leaching area....Z-f�`
,Lsq. ft.
Z Other Distribution box Dosing tank
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit_-______-_.______- Depth to ground water."-"_-_-__ ----____._..
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___"___-.---"_---___---
................. -------------------
..............................................................................................
, V.. , ..............
0 Description.of Soil............................A ----------------------------------------------------------------------------------------------------------------
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 been/issued by the board of health. "r
Signed j
--------- AX,......................
Date
Application Approved BY................. ........ ..
----------------------------------------------------- ------------------. Date
Application Disapproved for the following reasons:......................................................................................_........................
.........................................................................................................................................................................................................
Date
PermitNo../..................................................... Issued-_-----------------------............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF....
........................... .........................................................
. Tatifirate of TI-Intlifiattrr
THIS IS TO C..URTIF, Ahat the Individual Sewage Disposal System constructed or Repaired
by.................. ................................................................................... ............................................................................................
at......... ------------------ ------------
------------------------ ............................................................................
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit'No-------------1,-) .7
. ........................ dated----------_ _3_....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................................................."I,*,,--- Inspector......................................................------------................
THE COMMONWEALTH OF MASSACHUSETTS
Ada BOARD OF HEALTH
......................................... OF............................................
No...............7 FEr�....... ...............
Permissionis hereby granted.............................................................................................................................................
to Construct '�.@r Rppair ( re),,an Individual S�nv�ze
41 -#Disposal Sygtemf'
d > "•7 ? I
/ j le - --
at No.--......................................... .......7
Street
as shown on the application for Disposal Works Construction Permit No---------------------- Dated-------------------------------------------
------------------------------------------------------------I............................................
Board of Health
DATE--------------....... ..........
Hoges FORM 1255 ARREN INC.. PUBLISHERS