HomeMy WebLinkAbout0314 CRAIGVILLE BEACH ROAD - Health (2) re
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Application
is hereby made for u Permit to Construct ( ) or Beouc ( ) an Individual Sewage Disposal
System at: ^
'�� ��______.____.�'��'��'TJ----------------'
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.......................................................
Addres s
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Type of Building Size Lot_-- feet
Dwelling—No. of Bc6roou`a-.�~~- ---------..Expuosiou Attic ( ) Garbage Grinder )
Other—Typeof DoUJiog --..-------' No. of persons---------------------------- Showers ( ) -- Cafeteria ( )
04 ()t6cr fixtures .... ------------------------------------------------------ .----.-----------------.----_-'_.-
D ' Flow............................................gnU000 per person per day. Total daily flow----------------------------------------
Septic Tank—Liquid capacity------------gallons Widbb ----- Uiamcter----- Dcyd`-----.
Disposal Trench--0ko. ..................... Width-------------------- Total ------------------- Total area---_--..-sq. b.
Seepage Pit 2Vu_.-.-__- -------------------- Depth below inlet.................... Total leaching area------------------sq. it. �
Other Distribution box ( ) Dosing tank ( ) �
~~ Percolation Test Results Performed bv......... ---------------------------------------------------------------- Date--.--------.----
Tcx Pit No. L-_---minutesye/incb Depth of Test Pit.................... Depth to ground wuter--------
Test Pit No per inch Dco16 of Test Pit.................... Depth to ground wztcr'-''--'_.
'- ---------------------------------- ......................................................................................................... ............
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0 Description of Soil.------.-----'--_-'--_-_--._-_-'----_----_----.------.------.-._-.-
_--._---------._.-_---.----_------ ----. -'---'_.-__.--.------_-- �
-------------. -_-.. ' _--_- . ----- --. --------_--_---'' _--'- �
| U Nature of Repairs or Alterations -
__.______..------------------------------ - p^'^^=*~�~�e�'-`~--'~'~~'~ ^~�-~^'~'~��'~=~~ =�°�--^=,�~~"`,'~~~°�~�^--
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o`�ot� - �
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 furtbcragrees not to place the system in
operation until a Certificate of Coozy\iuuceb '
2
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Application- - - -,,''v__ By..... -_-.-----'''_-''
. /� ~~^ `
��pyucuuou Disapproved /or�e following reasons:.................................................................................................................
--`-----'-----`---'-----`---------'--------------`--`--`-- ---
Date
Permit -�/Sa t�e
-----------------------:----------------------------------------------- - - --
�
`i
No.. ................ .............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH
OF.9
Applirtttion -for Dbtipvfial Works Cnomitrurtion Vrrflifi
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syt
cation-Ad _ or Lot 1No.
T — .. -------------------
Ow Address
0
W �... .... . ........ .... �'1P � ... ........................_.-_..........__..._......._.._.....
a staller� tir Address
Q Type of Building 4 :, Size Lot..................... ......Sq. feet
U Dwelling—No. of Bedrooms.__-'' -•-__.---•----__-_-.___-_--Expansion Attic ( ) 'Garbage Grinder ( )
Other—Type "of` Building ---------------------------- No. of persons _-___---_:__-•__-__----_ Showers ( `') — Cafeteria ( )
P,
they fixtures _ _____ ________ .1.
W Desi n Flow......................... .. Mons per person per day. Total daily flow---:__ ,-_----__ _----._ .gallons.
WSeptic Tank—Liquid capacity!T _____gallons -Length-----------_-- Width------.--------. Diameter---------------- Depth----------------
Disposal Trench—No- ---_-__--__ =Width_=_ _-__-__-_ Total Length--------------------=Total leaching area-------------- -.---sq. ft.
Seepage Pit No..................... Diameter, ;Depth below inlet ...............kTotal leaching area._...._.____.._.__sq. It.
Other Distribution box Dosin tank" �>
' Percolation Test Results Perforinisd b ` "`' y ate
Test Pit No. I................minutes per inch",,Depth�f.-1 est -P„it ._Depth zto ground water------------------------
44 Test Pit No. 2................minutes per�'inch D"eptpi bf�{'1�0.Pit---------' Depth to- ground water...................... .
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O :
Description of Soil-------- ------------------- - -------------- b ---------------------------- - --------------------------------------
V -----------------------------------------------------------------------------------------------------------=---------------------------------------------------------------------------------------
UW --------------------- ---------------- .............................................-----------•--------------------------------------------------------------------------------- ------
Nature of Repairs or Alterations---Answer when appplicable_-_--------------- `__.. -----
------------------------------------------------------- '
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 b ii sued b the boa o e h.
Signed ,-C �. et , '
• � Date �-
Application Approved By __.-�
Application Disapproved for' following reasons------------------------------f.....-•-----•-•-•......._.......................................................Date
Date
Permit No.
a;: �•
--....... Issued. __.'✓-'R ..
,•,;,,.n;--Date ?
T.H.E COMMONWEALTH OF MASSACHUSETTS
.BOARD OF HEALTH •
e� ,wlh-........OF..... >'6dte......... ..
Tntifiratr of Tomplittnrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed, ( ) or Repaired ( )
by.................. ` .._.._t' SSl4Ge.S
.......................................... .....................
Installer
has been installed in accordance wlthithe provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permii No.f ...... ----------------------__-__ dated...-/'_ '_ '�1.....................
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GU RANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE__. == = Inspector
u .
i:u;' 7'r,.a" '' a s S ±.a•;a +-E .�`<.ta''.IN �""""krE62 . 'id a... s '
THE COMMONWEALTH OF MASSACHUSETTS 41
BOARD C t `:'HEALTH
bl -
O F.... !!?. h..........�C�'.............................................
No. = �� FEE........................
Permission is hereby granted------- _ !.!,°.......<_, S,��Q���------------------------------------------------•-------------•---------•--
to Construct ( ) or Repair"( an Individual Sewage Dis osa� Systepi
at No........3 14,1- -_,e -------=• !-f //,-v4'T ---
-----
Street
as shown,on the application fbix Iisposal Works Construot o Fermit No. .G_____--_-- Dated.._.._----�-.�"_.'7`�_........
•Fu r ..,t. :. , MF:t w.
C,
A ----
•------------------------------ ---_t,l.� --- .--s:---------------____
DATE_..... Board Health
FORM 1255 HOBBS & WARREN• INC., PUS 'SF'1'ER
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