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Home My WebLink About0424 CRAIGVILLE BEACH ROAD - Health LEI Ll TIP,- 0-��Illlle P" ��dzrcr Ac,"/x A/toa Avg' o�C�6 LOCATION SEWAGE PERMIT NO. tt 0171 VILLAGE a INStA�4ER'S (A�ME A A,DDRESS N U I L D E R 0 OWNER DATE PERMIT ISSUED Z-ATE COMPLIANCE ISSUED 1 f ' � •+ � r� r � . '�� i �• � P N ..sa �a iX "'� Fms... !1Q o.l THE COMMONWEALTH.OF MASSACHUSETTS BOARD 9F HEALTH J N ....:--... -.o 1 OF......ane, �S 1•�Q.............. Appliration for Uispwi al Morks Toutitrurtinn Vanfit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal Syst t: ....... ...Box))..M------------------ .................-................................................................................. Locatio ress or Lot No. ..... 1" L!_L?1C - 1. �'-.....................: = s...H -.--........-----•------•---•--......................... O er ddress Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—T e of Building No. of persons____________________________ Showers — Cafeteria 0.' 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.......................................... 1.4 Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ • ... ......................................................... Descriptionof Soil................ �.]!L....__. .42VItj............................................................................................. x V -------------------------------------- ---------------------------------------- _------- ••-•------------------------------------------ W ---•------•--------•••---•-••----•---••-•••---••----•--•-•----------•---•---------•••---------------•-----•-•••------------•-••---•-=-----•-•---•- UNature of Repairs or Alterations—Answer when applicable------1__10or-___ a)--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Si ned_._.._.- A . ••...'•••• �f:��'��Zl�/i ......0—J )19_. / Da Application Approved By----- - -------•------------------------ �f'-__ `---� Al Date Application Disapproved for the following reasons:.............................................................................................-------------------•- -...-•--••---•-•--•---•-----------•....................••----------.........------------•--.----..-.._.__. Date PermitNo......................................................... Issued...........................---•-••----•-------•--••--- Date 4 THE COMMONWEALTH OF MASSACHUSETTS _ BOARD A. F- HEALTH .......... .... J—�'` �e- r' �' ............................ ApplirFa#ilan for Disposal Works Tonfitrnr#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal Y -. S stet• Jk j}/t �qSj / Locatio ��ess or It No. ... �.1.A .. d ........G. , A ------....-•....................................... er � 1 .ddress a ----..s.✓f:. �'_ ? '._ :: c-- -----------f �°`�� '..--------------------------.---------..---•---- Installer Address UType of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ---------------•-•--•-••--•--••. ell .-.-.-------------------------------------------------- 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 ( ) PercolationTest Results Performed bY.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ ........I.................J•----•-•-- ----------------• - D Description of Soil................ ��_ ;.'�_ �:. °�-� l` �.�y�.........................................................................••-•-----------........----.........._.......--•-------•---•-- x c., W ••----•••-••------••••--••-•---•-------...•••---•-•----•-----••••••••--•-•••••••••••••----...._•............... UNature of Repairs or Alterations—Answer when applicable /� '�✓ % ° ........... t`zy.............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI2 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 lav SI Date .. ------•--••.............. -----.Application Approved BY-----•----•.. - - f'�....Z:/ , Date Application Disapproved for the following reasons:-•-•--....------••--------•--------•----•--------------------•----------------------------•-••-••--•---•-...---- ..................••--.....---•--------......---•----•--•-•...............-••••-------......_...............----••--•--•-•--•---- -••-----••-•----••--------.._....._..--•---••---••----•--••-•......-•-- Date PermitNo......................................................... Issued................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trdif irFair of Tomplianre THIS IS-TO,CERTIFY, That,the Individual Seszge Disposal System constructed ( ) or Repaired (, by 3 at � t _ 1 p� (� InstajlN f / Line. /f'f _ has been installed in accordance with the provisions of T 2 LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ................. dated-................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM-WILL FUNCTIONS TISFACTORY. DATE.'j--------- �� /Xf--...-•---------------- Inspector. -----------•--•-----------•--....-- THE COMMONWEALTH OF MASSACHUSETTS .._,,. BOARD OF HEALTH 1 � r C �, l No. _ FEE.......�.i` .--- Roviva olgi Tunstrnr uan �e nti . Permission is hereby granted.......-==-`-- ---•---- -------------.--Or '�-.�,�..... ------�-- ---............................................. to Construct ( ) or Repair ( an Individual Sewage Disposal System atNo................................................................... -••--•--•---......•-----......••--•----------••••-•-•------•-----------•••-•-•-•--•••••••---•--••--•••----•................ Street as shown on the application for Disposal Works Construction Permit No....................• Dated.......................................... ................... / / � Boardyof Health /DATE-•---•---•-------.... ..:.;.•---•----:,,--------�...-•........................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS