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Home My WebLink About1314 CRAIGVILLE BEACH ROAD - Health (2) �3l y Crcn ,R.Qy' .�c,�) � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OL oF...-. . '1x57 _ . Appliration for, j3hipliml Mirkfi Toustrartinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....�c � ... Y .1. .� )j4...... .. .......... ..............:.................................................................................. ...Lo 'on-A Jd ess or t No. I ............ �.l .......................... ....... Ow er ress a ....a_,t ,..1 Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building .:.......................... No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------•-•---••-•-•---------- 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 ( ) a Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................mmutes per inch Depth of Test Pit..................... Depth to ground water--_-_-_-___-___---__,__. (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ads---p ODescription of Soil........... ....�� •----------------------------•-------------.---------.---•-••-•-•------------ x -----••. ---------•-----------------••-----......- ----.-•-----------------------•----------------------------•----•--•-•----•-•--•- -----•--------•----------- -............ -------- U Nature of Repairs or Alterations—Answer when applicable............../.__ �v _._....F/.................... -----•----------------------•----------------------------------------------------------•-----_---------•-----------------------•-----------•-------------••-----------------------------•••••••----..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTi,,p. p of the State Sanitary_Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the board ofh Ith. J/ Si ned..... D to Application Approved BY + � ,R/......... Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•------------------........_..... .......................=................................................................................................................................................................................. Date PermitNo......................................................... Issued-....................................................... Date _• 4 Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH a .../,L : '� r .........OF..... Appliratiou for Uispuaal World Touti rurtiuu 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at t� .... 1 ; 3....j rt 5 +T' Q�.':+•� �"'S !_� -•...... ............ ... ... ...._ ........................................... Locat ff-t Ac sev,3, ' �".. or t No - . .._. r- t !s'� _fr!-.[ ......t.rjlg•ra� !�r''. •--•- ................ f 1�'r;.}.'�C rstx:i¢.•'.,• ............................................. ......... ,{ Owner 1 e J d dress = - = 1 f O .............. Installer •� Address Type of Building Size Lot............................Sq. feet .—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria al Other fixtures .................................. 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........................ RS; .........................................---......-------•-----••------------------•-...-••-....-- Ij Description of Soil.................1,Z; ........_..------------------------•--------------.._.........---------------------..__.............__. V W ••-- . ------------------------------••-•••......•--•-•----••• ••• r' - ------•---- 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 TITIE 5 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 _ Signedt ..........................ee C - Application Approved By Da e 1.4.........Y ------------••---_-- ........ .... 'e ._:._. Date ' Application Disapproved for the following reasons----------------•------------•---------------------------------------------------•-•-..••--• ---•••--•---..._. ....------•------------------•----...------••-----••-----•---•----------------------...----•-----------------••-•••---•--•••-------•-- ••------------ ---------------•---•-•----------•-•--•--•----Date PermitNo......................................................... Issued-........................................................ Date THE:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF......°r�,.i::x r .� -s 6c r� f C Trrtifiratr of Tumpliatta THIS._LS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )' by ¢ 1 � r n�C { r�l1 fj x ,� 1, I�l ! x ,r Y �r d-,t a x �.. at .... .....- . . f .............. .........--•---.......:._._.?< -- rp. has been installed in accordance with the provisions of TITIE `> of The State Sanitary Code as described in the ' application for Disposal Works Construction Permit No._ , e?_SS�S............. dated----------------------------.----_----_.-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF�CTORY. I DATE.....---••.............•-•---•...........__.. J.[_[,UU t w .(....--•------•---- Inspector..................4 Y ( ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD /OF HEALTH • ✓ .✓s .... .....�..id F'lP . ..��........................... �• N FEE........ wed .......... Raposal Marko Tonstrudian Vamit ..�.r Permission is hereby granted /tf� 1 '`....��------�....c -�. _. ,•,� 15�............................. d 6 ................................. to Construct ( f o -3{Repair ( ) at) Individual Sewa e Di posal S�+sXjem `? ! ! k� ✓ ,.,. z' fps i- y •f/ L F s'� 1 titi✓6 at No -- € ----= - C ��_. '` ..� .. - .................................. 14 Y `4 Street as shown on the application for Disposal Works Construction Per' ' 0.......... {___ Dated.......................................... ----•-•--------•--•-----•- -Boar of DATE :�. Cyr ------------•------ ti FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,h