HomeMy WebLinkAbout0021 HARBOR ROAD - Health a
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THE COMMONWEALTH OF MASSACHUSETTS
_____POARD OF HEALTH
oF.................YojMrxTABL E................................
Applirtativaa -fur Disposal i9orkii Tonstrurtivaa Vrruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: `-
`. _ � G7��_'.- •.. //-Y_32�4 Lot N............................................................t o
Location.Ad ress or .
C 2/i1 -
O ner Address
--------------•- --------------•------•---••••-•------•-•••--•--•-----......---------....-------•---•-•------.-----
Installer Address
dType of Building Size Lot----------------------------Sq. feet
V Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons..----....--.---............ Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................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..................... Diameter.....---............ Depth below inlet......----.......... Total leaching area........---.---.-.sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------- ------------------------------------------------------------ Date--------...----------------------------.
Test 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...-..-----.--..--.-.--.
a' ----------------------------------------••-••----•-----•-----•---------•--•••----------•--•---•-•--••---------------••-----------------•--- ---------------
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------
U ----------------------•--•---------------------•-••-------------------•-----=----•-------------•-------••--...---------••-......-------••--•------------ -----•--------------------------------------
---•--------------------- ----------------------------•--•--------....-..----.-....------------•--------•---..-...----------•---------------•-••---------....-...---------------------------------------
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 been issue by th board f he t .
signed--------- -•-- -•--• - --- --•- =---• ----- ----•-•-------------•---
/ Date
ApplicationApproved By------ ..:` '------------------•-----------------------...-----------•--•--------- -•-•.....--------------D -ate---------------
Application Disapproved for &elfollowing reasons:................................................................................................................
..................................•-•------------....-------------------------•-----•---------•---------------------------------•------•----------••----------------------------------...---------------
Date
PermitNo.......-3' 6--1------=-------•----•---•--------•--• Issued........................................................
Date
Fin ..................•••.........
THE COMMONWEALTH OF MASSACHUSETTS F ''
BOARD OF HEALTH
.... . ..i�,7 .....OF................. L
Appliratiuu -fur 43iipufiai Worko Cnuutitrurtiuu Vanfil
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: /
Location-Oryss f or Lot No.
O ner _ Address
• r
f Ci/t d = ` �_+ . ........................ ••--•----•-•••--•---•--•--••••-•----••---...-•---••-•--••......---•••-------•--••......-•--•--•---
Installer Address
Type of Building . ' Size Lot............................Sq. feet
U Dwellin No. of Bedrooms.....................................- .____Ex Expansion Attic Garbage Grinder
a g-,r -
P ( ) g ( )
p, Other—Type of Building ____________________________ No. of p'Uson§,,____-_._---__-____.____._- Showers ( ) Cafeteria ( )
Other'fixtures " ---
----------------- -k� -----_---------------- ------------------------
W Design.,Flow __ . . :. gallons per person per day. Total daily flow............................................gallons.
W Septic 1 Tank.—LjgLuld eipacity gallons Length---------------- Width------ Diameter_-_._ ... .._--_ Depth.. . -. ._.. .
Widtli___________________ Total Length . Total leaching area------- ft.
x Dtspos�,T nch—No -- `--..------ g g 9
Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area------------------ ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------- ------------------------------------------------------------------ Date--.------------------------------------
aTest Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-----------------.......
Test Pit No. 2................minutes per inch Depth of Test Pit.___-•_ ---_________ Depth to ground water------------------------
----------------------------------------------------------------------------------------------------••-----•------•-----------------------•-----•------------
0 Description of Soil--------- --•-----------------------------------------------------------------------------------------------------------------------------------------------------------
U
W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer,when applicable...............---------------------------------------------------------------------------------
--------------------------Ada---- .x1F1__-t-- �G�.�r� .-' .3ra�t¢/�►,,yG1l�� -----------------------------------------------
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 issue by tha board f h l
igned - ---•- -- "i. gr'- -
Application Approved By / <, t -••W-• ---- --------------------Date----------------
4 µ:. -,
1
tN K� Date
Application Disapproved for w e'following reasons-----------------------------------------------------------------------------••-•-•-------•---------------------
••••-•.......•-•-•-----••-------•._._...----•-----------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......5�6 1.....'.............................. Issued---------------------------- ••--............
Date =.
THE
COMMONWEALTH O}lF MASSACHUSETTS
5
BOARD OF -HEALTH
/�r�,:r�- ......OF.................8 1!1�TA1&�. ........... .............
................. x .
,.n ..;,, 1Q.1rrtifirutr of f"omphaurr
THIS IS TO C TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by /�•�L cr--U�� •. •---•-----------
I staller '
at•.=•- ........_.7.17 'Aole_-------lifd-- f'' _X*A'�2-=✓"� -------
h
as been installed in accordance with the provisions of Article, I f The State Sanitary Code as described iru 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 FUNCTION SATISFACTORY.
DATE,,.- - = ..................................................... ' Inspector....................................................................................
X THE COMMONWEAL- '�=-F"2"N kAp,,�ACHUSETTS
BOARD OF HEALTH
......o f...............EAR iSTAKE...---.......------.....---...
.. -0 a
No......... ............. FEE-�.
4. %xivulittt NOrkii -Cnuuitrurtiuu Vrrmit
Permission is hereby granted---- ---------------•-------------.....---.....------------------------------•------•----.
to Construecctt ( ) or Repair (X) an Individual Sewage Do s I S stem
atNo. oa 1-0t�6a/... •------. 4® z �---------------------------------------------- q -
Street I// �.4 / r 7�
as shown on the application for Disposal Works Construction Permit No S__h_r__:_. Dated-------- 2 /
rd of Health
DATE...... ------•----------------e .................r�
FORM I255 HOBBS & WARR N. INC.. RUBLISPERS
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