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HomeMy WebLinkAbout1204 CRAIGVILLE BEACH ROAD - Health (2) Ce lO'k1�1O6 RS fi t ^ i 1 alai^ No. `r 'co � UO��� a'Y`r....of MA S BOARD E HE TH ............ . ........................... ....... ApplirFatinn for DhipdFal No s Cnnniunrnun rnmit �- Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:* ',, .Z _ 1 ?' .��- - -- .0 h?Z? ill - C>® 7 ►t i�---.....---•........................................... Location-Address, or Lot No. r. � -------------•-----------._... •----.............................................. Owner Address Installer Address dType of Building Size Lot....... feet welli —No. of Bedrooms.._.._.....y-........................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................. Showers (''L-- Cafeteria ( ) Q' Other fixtures ------------------------------- . . W Design Flow...............1.1_a....................gallons per person per day. Total daily flow..............?................gallons.. WSeptic Tank—Liquid capacity.1 gallons LVngth................ Width.......,........ Diameter---------------- Depth................ x Disposal Trench—No.----- ............. Width.Z.S......... Total Length......3,....... Total leaching area__`�-----sq. ft. t Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..........._......sq. ft. Z Other Distribution box (A Dosing tank ( ) Percolation Test Results Performed by----------- ---------------•------•---------•--------------•------•------- Date........................................ ,a_l Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water___________--------____. (s, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ O Description of Soil------. -.....----•��.. .............- ................................�I t4 J��=..5��--------------� x. _ Nature of Repairs or Alterations' Answer when�a�lliccaable.______ __. .___ _ _ -................................. WT -b- -- �--'......-••-------•-------•-••••---•---••-----------------•---••....•••-••--•-----------•---------------------------------=..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i _,u p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ss �bytheoard f h t .S igned Application Approved By... I .. � ' Date Application Disapproved for the f oll ng reasons:•--------------•-•---------•----••••-•--•------------•-------------••-----------------------•---•-••-.........._ ---•-----------------------•-------------•---•----...--------------------......------------•----------------•--------------------•---------------•-•-•--------. Date PermitNo......................................................... Issued_....................................................... Date '.6 No. ............k y �r+e FEB . ............. COMMO ALT OF MASS$C tk' BOARD F HEALTH -. pp4rFa#ion for Uhip ti al Workii, Tunutratrtiun thrmit Application-is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at re'ti L...... � '4`�....... . d� ly�� �CC,�,�ta„�.."� � 4Y+�.�r"7 fR{'�,�. .. ......... ..... .................. ......... .......:. .................. ...-.....--..........._..........._._--.._....._..._....._...................._......_._.._...._. Location Address § or Lot No. .. :.X ^, rZi .... C.L 11;F.0.?.___�......................... = Y Owner Address Installer Address Q Type of Building Size Lot.____...:"_fi...°......Sq. feet ('IA3,li —No. of. Bedrooms___....... ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers �.,� — Cafeteria a yP g P ) ( ) Q, Other fixtures ....................................... Design Flow.................3___O.....................gallons per person per day. Total daily flow............. ._. ................gallons. WSeptic Tank—Liquid capacity(, gallons Length................ Width................ Diameter................ De ___.._.._.... x Disposal Trench—N?o. ..A.............. Width.�� _ ..._...... Total Length..... 5y....... 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of Test Pit......... .......... Depth to ground water...........:............ P4 -- ----------------- --- -- - ----- ------------ Descrip tion of Soil......___. • x U n r ¢. ...i U Nature of Repairs or Alterations—Answer when applicable..._ __ `' ••-•••.... Wig. —4 _'.'_-_.'.'.................."___"____'_"---'•------....".'__' Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti'l I . ; of the State Sanitary Code—The undersigned further agrees not to place the system,in operation until a Certificate of Compliance has been.,isss es by th �rd o f Signed.' fi, •. ......--- '.-�.-�'-...... . .. . r_ 7 � ace . Application Approved Byt .-- .......... ... .....................•-•----- --•-- .................. .- Date Application Disapproved for the f of 0ing reasons:---•-------•......----••-••----•----•-••-•-••••---••-•-•----•-••--•-•••-••••••-•---•--------•-•--•-•-......----- ---•--••-•----•--------•-----•-------•••••-•-•----••-•--•••••••-•-----•••----•---•--•----...•--------••-.-••-•-•------••----•-••••-•--------•---•----•-••--••-•••---•-----•-----------•---••--•••------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ��. ..........O F..............'°:�-,- ^°� ............................................ �rr�ifirtt#r�'.,af (�uut��i�anrr T S IS TO CERTIFY,,_That the Individual Sewage Disposal System constructed ( ) or Repaired ( } ' , �° l by......a: .. ..5_..4 � _ .. - ---------•-------------------••------------.....----------•--------•------- I alley F ata ........ .r.r :" 4 �" ' ............................................................... has been installed in accordance with the provisions of T A-lT le, 5,.of The State Sanitary ode,asde!icripred,- ;n the application for Disposal Works Construction Permit No.- ._ :_r__`_'�................. dated _:"":..'_______."_:.-_......_.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... -— 1 -.. 5- ......................... Inspector. ............................ • •-----••-•=----•-•.... 94 THE COMMONWEALTH OF MASSACHUSETTS C� r BOARD—OF HEALTH ........�...�..=„s...�................OF..... ......... ......:.. . .............._...._.._....._................. FEE.......................• Utop gal urk.5 Tunutr ion rrutit Permission is d. hereby granted ................--------• --------------......------.....--•-•................... to Cons``tr-yyu��c�tt��jj( ) or Repair ({ 'tea an Individyual Sewage Disposal \System at No...-El�Pr?-t._ ��1�"?�4�s�L L �_ �R���E l F �.�4� �'"�7w�`Y° �4r�l 9L�in � A� tf'-iC . �. Street y'. 'i as shown on the appli,',.ation for Disposal Works Construction,Permit No ................ Dated............................ '� ` Board of Health 'DATE. - ........E _........................ FORM d255 (0 S & W.AR.R TN. .INC., PUBLISHERS ��►.1 Z% �-� Opt t-o'I� S`(bl�j••� I D. 2 �asr{F-0 s,n,u G ( y1a, Yz 2.0 1 2. 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