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HomeMy WebLinkAbout0012 MEGAN ROAD - Health �a me-C/ait RI ,, Nonni t No..4.1-1, Fps .................... THE COMMONWEALTH OF MASSACHUSETTS E30ARD PF HEAL ILA OF....... 41(" Appliration for Rapp al Works Tomitrurtion Vrrufil Application is hereby ade for a Permit to Construct or Repair an Individual Sewage Disposal Sys at... ......... . . .. ----------------- tio ress or Lot No. Owner Addres s ....................... -------------------------------------------------------------------------------------------------- - Installer Address Type of Bulldljg Size Lot.............e:-------------Sq. feet U Dwelling No. of Bedrooms Dwel ...........................................Expansion Attic Garbage Grinder ( 1-1 PL4 Other—Type of Building ----_---------------------- No. of persons............................ Showers t Cafeteria ( P-1 Other fixtures Design Flow Z---------------------------------------------per-day.'- ------Total---'-------daily---fl-_o...w........... ___._____gallon,.---,,---i'" capacity W �)---------gal ons per person Liquid ca /?1&allons Length................ Width_._-_____.__._.- Diameter____-___-___--__ Depth______._____._.. 04 Septic Tank(.............. Disposal Trench—No..................... Width...._____ ^th-------------------- Total leaching area....................sq. ft. Seepage Pit No. 4 Diameter 0 Kw— �Wt'h4014 inlet.................... Total leaching area...--------------sq. ft. -- -------------- f Z Other Distribution box Dosing tank aPercolation Test Results Performed by.......................................................................... Date.-------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit____......__.__..__. Depth to ground water------------------------ PLI Test Pit No. 2................minutes per inch Depth of Test Pit epth to ground water-.__-_..___..____._-____ ----------------- --------- - --------------/- ---------------- ----------------------------------------------------------------- - ------------------------------------------------------ 0 - -- ---------- Description of Soil------- ....... ....... .... .", ---------------- .................................................................................................................................................. ------------------------------------------------------- ------------------------------------- .................................................................------------------------------------------------------------------------------------------------ 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 Article XI of the State Sanitary ode The u4rsi ned further agrees not to place the system in operation until a Certificate of Compliance has be F" iss by th of healt . Al T-01 Signe ............. ............................- --------------------------------- ote,I -- ---- ------ Application Approved BY------- I... . . . ...... .. .... ...... Application Disapproved for the following reasons:........................................ ...................................................................... ........................................................................................................................................................................................................ Date PermitNo.......................................................... Issued........................................................ Date - - --- ---- - -------------------------------------------------------------------------- ----------------------------------- No.... _= _....... Ficim .�s2.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;� ; �, � ' r . ..... ........OF..... y Appliration for Disposal Morkii C oustriartiou Prrutit Application is hereby ade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Seat* L tiori A` ress y� or Lot No. ti t !el 1 Owner ...............................••.. _...Address-----------•------•---------•-............. Installer Address d Type of Buildin Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) •___________________________ No. of ersons.._.._...__.........__..____ Showers — Cafeteria p., Other—Type of Building p ( ) ( ) P4 Other fixtures Design Flow___________________> ._._ .....___ Mons per person per day. Total daily flow.._....._ gallons. W Y Y , ----------g WSeptic Tank Liquid capacity,/ Mons Length-----------_--- Width................ Diameter-.._ ._- .__ .-___ Depth--- _-.---__-- x Disposal Trench—No- --------------------- Width:. of 3�� li.................... Total leaching area--------------------sq. ft. Seepage Pit No.... Diameter 'e ow inlet____________________ Total leaching area_._____________...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation 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____-__-________-___--_. -- D Description oS f oil-------------- - t ---- -------------•--- ---._.......------.._...--=-------------- - U ----------------------------------------------------------•---.............................•... W UNature 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 Article XI of the State Sanitary Code— lie and rsl ed further agrees not to place the system in operation until a Certificate of Compliance has bee F issu , y the l6a d Of health.' �. Signe .... ' ......................... ./...../.......;....... ., A lication Approved B �' -�__ .... _ PP PP Y ..:.,. {�r�' Date--------------- Application Disapproved for the following reasons:.......................................... -------------------------•----.---------_-----•-------------••••-••••----•--•----._......------......---......-•----• •-------------------------•-•-.•--------••-•---- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA. TH ....«" ". .........OF.........:..:.:. .......................................................... prtif iratr of TOmptiaurr � T1sPF5t 1 CE "Itl*'& dual Sewage Disposal System constructed or Repaired g P �' ( ) ( ) b - ------------------------------------------------------- ------ p "zl nstaller ' has been installed in accordance'fivith the provisions of Article XT of The State Sanitary Cod_ as described in the application for Disposal Works Construction 'Permit No......../.V> ................. dated,-//s=_ ;r..; -------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. 3 Inspector ........................................ U'..f-�------•------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r' � + ...... .. ..OF... ' ,�.. -� `' .......................... Frizz DisoiBal/Riorkii w on rurt� it W rtitit Permissto I ereby granted; ...�1.. � --------------------------------------------------------- to Constr Y ) or epair4-A ) an Individu 1 �ewag �Dtsposll System atNo.-' f.n,5'� ------l_ffl-'l , ----------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction P mit -^.. ___ Dated._k . ._...__ R✓ ---------- ,1''� �� Bodfd of Health DATE.......... _.: _ ` , -' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - � sx� - Nam : A ♦ t� t-s~`✓°'�' .p ll� '.�+at .av a -i. s.. --= k-• et :.32L"t, cr, .Q.. -_ .r•,.-� ..e -LL tk :� i ;''s6R`J `'mot i - - F+t f : � 'a: s q r� t71 ; �`r ♦ i Z - -F'.l",r_ x Y �.- ..'cam - Q _ _ - - s _ 11 - '- #- ,. .�',i ,�`- " , ter"!5 11, 1. 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