The URL can be used to link to this page

Home My WebLink AboutSeptic As-Built Card Town of Harwich Subsurface Sewage Disposal System As-Built Card PLEASE TYPE OR PRINT CLEARLY Street Address: q La I o ff-‹ 2,0 Owners Name: Da+'^5 Y)ar-, +ram ek r14ji ) Date of Installation: (P - 5- c9 3 Permit # 2'3- 3q ya Installer's Name: S pe A rY-nG '1 e xcava-fi y-Q 2-LC . Installation of: (list all components installed under this pWmit): S q SA-e rr) - ) (300 S*. t-4 . 2 v .,.._w.___`_ Y/LED i-- ioX t-- 5 S , .IUN 1 2 2023 HEALTH DEPT. Certification of Installation As the Disposal Works Installer, I certify that the system has been constructed in compliance with 310 CMR 15.000, the approved design plans and all local requirements and the following: Y V N N/A The septic system has beer_ installed at the elevations shown on the approved design plan. Y (V N N/A The septic system was installed in the location shown on the approved design plan. Y N N/A V The Design Engineer and Health Department were notified of changes to the approved plan. Y N N/A jL All unsuitable material was removed and excavated five feet laterally in all directions beyond the outer perimeter of the soil absorption system to the depth of naturally occurring pervious material and replaced with clean fill. Y (2 N N/A The building sewer has been connected to the building. Y 1/ N N/A The septic tank inlet and outlet covers, distribution box cover and leaching facility cover(s) have been brought to within 6" of finished grade. Y N N/A The pre-existing septic system was pumped, filled or collapsed. Y L.../ N N/A Final grade over the septic system components does not exceed 3 feet. Y N N/A All other permits obtained and inspected as required (electrical, plumbing, water). Signed: _ Date: /, -6j'23 System Installer SEE DIAGRAM ON REVERSE SIDE Subsurface Sewage Disposal System Diagram PLEASE PRINT CLEARLY p r - 4. (1k91 4.19_,41 ffaLi@agivID Ait4 itts 1:11,0:11:TH DEPT \43 111 r4- L) , a/WA t A B C D 1 134,1 31-6 %S I/5,2- 1114 4 74' (66-1 2- q'F'10 /71q 4 =Mel Town of Harwich Subsurface Sewage Disposal System As-Built Card PLEASE TYPE OR PRINT CLEARLY Street Address: c 1 I 2 Uv Owners Name: �C(r (} GrAcIci h Date of Installation: La Permit # FpCl Installer's Name: spe tyytrA f Ca JG { Installation of: (list all components installed under this per ): a1.DWCD 1 S&161-( Ack CI Si' i-176) V SUN 1 2 2023 S l63),S H CALTI i DEPT. Certification of Installation As the Disposal Works Installer, I certify that the system has been constructed in compliance with 310 CMR 15.000, the approved design plans and all local requirements and the following: Y V N N/A The septic system has been installed at the elevations shown on the approved design plan. Y 1/ N N/A The septic system was installed in the location shown on the approved design plan. Y N N/A tv The Design Engineer and Health Department were notified of changes to the approved plan. Y N N/A ✓ All unsuitable material was removed and excavated five feet laterally in all directions beyond the outer perimeter of the soil absorption system to the depth of naturally occurring pervious material and replaced with clean fill. Y 1/ N N/A The building sewer has been connected to the building. Y i/ N N/A The septic tank inlet and outlet covers, distribution box cover and leaching facility cover(s) have been brought to within 6" of finished grade. Y j64 N N/A The pre-existing septic system was pumped, filled or collapsed. Y V N N/A Final grade over the septic system components does not exceed 3 feet. Y N N/A ,, _ All other permits obtained and inspected as required (electrical, plumbing, water). Signed: - _ Date: to, -J ' ystem Installer SEE DIAGRAM ON REVERSE SIDE Subsurface Sewage Disposal System Diagram PLEASE PRINT CLEARLY I P (. 'r ---. 75, il 1 lig , ' JIJN 12 2023 0 c ,,...h. j 11' HEALTH Dtizfi Sf -S-?. c , o , ...., . i 1 L 1*-- E_______ f III i 03 ai z it Lo A B C D I x 5-2. 244.11 I %% 14 -12.% aa,3 4 11, 3 a3,s l s_" i SLID 1%6 `blaq a3,to1 I -1 51.JD Life-t L Town of Harwich Subsurface Sewage Disposal System As Built Card PLEASE TYPE OR PRINT CLEARLY Street Address: C Lp I QC,ult-c 2� y Owners Name: - (_,(ShCA.Y\ C71 C-h Date of Installation: Co Perm t # — s cpL7 Installer's Name: .p.c& klyyl crt £ KCti va n LLC Installation of: (list all components installed under this pe it): ctifsk ni - ti c- 2O -eoy )4-S Certification of Installation As the Disposal Works Installer, I certify that the system hi s been constructed iff--Ls compliance with 310 CMR 15.000, the approved desi 1lI plans and all 1oc�4 1 2 2023 requirements and the following: Y [l N N/A The se tic s stem has bee installed at the DI=PT. elevations shown on the al .roved desi: .Ian. Y N N/A The septic system was installed in the location shown on the approved deign plan. Y N N/A The Design Engineer and I ealth Department were notified of changes t. the approved plan. Y N N/A L' All unsuitable material wa. removed and excavated five feet laterall in all directions beyond the outer perimete of the soil absorption system to the d:pth of naturally occurring pervious materi.I and replaced with clean fill. Y N N/A The building sewer has bean connected to the building. Y V N N/A The septic tank inlet and o i tiet covers, distribution box cover and eaching facility cover(s) have been brough I to within 6" of finished grade. Y � , N N/A The pre-existing septic sys em was pumped, filled or collapsed. Y l' N N/A Final grade over the septic .ystem components does not exceed 3 feet. Y ? N/A All other permits obtained : d inspected as required (electrical, plumb', g, water). Signed: Date: (a-5- Z3. --System-installer SEE DIAGRAM ON REVERSE SID Subsurface Sewage Disposal System Diagram PLEASE PRINT CLEARLY a 2... 1 b 6 al I I II S 4°P\ ''' a il ' 5 ..-(,..,-,-,,-,--,,,„.D : A ' V s '.,)ir JUN 1 2 2023 : q HEALTH DEPT o vet.;ea ver, i` A BCD i 112. 141.01 toq.c LICI 3 ' 1o9 (P 47.q 4 t OD 3L1 -i1Th (Pt '3 11,5' Town of Harwich Subsurface Sewage Disposal System As-Built Card PLEASE TYPE OR PRINT CLEARLY Street Address: GI Le ( Q,015\ f' '- Owners Name: DCYShCt Y1 —1 Girl C,k i Date of Installation: t p �j 2j Permit # Z _ 3ci Li e Installer's Name: S Installation of: (list all co ponents installed under this permit): bis UQo cpst- Z6 ` C c( S S Certification of Installation As the Disposal Works Installer, I certify that the system has been constructed in compliance with 310 CMR 15.000, the approved design plans and all local requirements and the following: Y V N N/A The septic system has been installed at the elevations shown on the approved design plan. Y V N N/A The septic system was ins p.filed in the location L` L5Db1D shown on the approved de.ign plan. IN 1 2 2023 Y N N/A V- The Design Engineer and ealth Department were notified of than:es ti the approved plan__ TH DEFT Y N N/A V AlI unsuitable material wa. removed and excavated five feet laterall, in alI directions beyond the outer perimete i of the soil absorption system to the d pth of naturally occurring pervious materi.1 and replaced with clean fill. Y V N N/A The building sewer has be,n connected to the building. Y V N N/A _ The septic tank inlet and o tlet covers, distribution box cover and leaching facility cover(s) have been brough to within 6" of finished grade. Y {/ N N/A The pre-existing septic sys em was pumped, filled or collapsed. Y �" N N/A Final grade over the septic system components does not exceed 3 feet. Y N N/A V All other permits obtained . d inspected as required (electrical, plumb g, water). /1 Signed: Date: & 1'13 System Installer SEE DIAGRAM ON REVERSE SID Subsurface Sewage Disposal System Diagram PLEASE PRINT CLEARLY l 2. c� c> c) 3 L4 sr 1(41), - Pov *CltP\ \ 5u\WA 1 . JUN t 2 2023 • HEALTH DEPT. 1 a 9 r A B CD 30, 35b� � La a c4, 1.4 Z° 7 102�to 22. , I c+ 31 , fib,tv 9 13, 6 zoo.ro