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HomeMy WebLinkAbout0018 MEGAN ROAD - Health (2) z3971 3-17 S�4- N ................ 1 Fizim I....................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH .............OF..... ......... `-' Application for 43ilivas l Works Tonstrurtion Vanift � 2 Application is hereby made for a Permit to Construct ( Wor Repair ( ) an Individual Sewage Disposal Syst at ' 2� 23s Location-_i ress or Lot No. --------------- ----_- .. .... ..:..... W Own Address ------------------------------------------- Installer Address d Type of Building/ Size Lot____________________________Sq. feet U Dwelling No. of Bedrooms------- ............. ............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons._..----_._.__________._____ Showers ( ) — Cafeteria ( ) P4 Other fixtures ---- Design Flow................ 111ons er erson per day. Total daily flow.=..... �� gallons. WSeptic Tank-�-Liquid capacity//--- 'gallons Length................ Width................ Diameter•.__._.._____.__ Depth._______._..... x Disposal Trench—No...................... Width............ ___ a th___ ..._...__ Total leaching area--------------------sq. ft. Seepage Pit No. f ------------ Diameter.d � .... w 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 1:14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._____________..__-_.- ---------------- ------------ ....................p-�- ------- --- ----------------------------- O Description of Soil % w -------r..�-ice_---►'" _;11 2 ." x W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has G ........i by theZY par . o health Signed .°G . Date Application Approved BY �/ 2 ---�----- -- 7 " _..3 2Date Application Disapproved for the following reasons:.................:•------ --...-•-•------------------------------------------------•--------------- ..---.--•----------------------•----...--•----------•---•--•------•-•-----------.•--•.... ------•--•--•..•.------•-•-------•.----•----------•-- -----------•--------••--•-------------- Date PermitNo........................................................ Issued.......................................................... Date {� ---=------------------------------------------------------ ---------- - No. ......... Flgm... -................... THE COMMONWEALTH,OF MASSACHUSETTS BOARD )OF HEALTH Apphration for 43iopooal Works Tonotrurtion 1rrntit Application is hereby made for a Permit to Construct ( Vor Repair ( ) an Individual Sewage Disposal System_ at: (/]� �15 ��. 4 r.. I.. .. _._-_ p. - ____ _ __________ ..-_ _ .......................... - .____ Location-A�ess or Lot No. -�Own Address Tire, --•------------•--- Installer Address Q Type`of'Buildin�g,� Size Lot----------------------------Sq. feet ' U Dwelling�& of Bedrooms_-___. ................................Expansion Attic ( ) Garbage Grinder ( ) pOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ---------------- ------------ - - Desi Flow________________________ Mons per person per day. Total Bail flow._-._____ .,,b W ---•-;;.� P P P Y Y ---......................gallons. WSeptic Tank Liquid capacity/� _�'gallons Length---------------- Width-____-____--____ Diameter---------------- Depth_______-_____--- x Disposal Trench—No- ____________________ Width........_-:. _: pTotal gth__ ___ _-__ Total leaching area--------------------sq. ft. Seepage Pit No------ ---------- Diameter./;✓ --- .�Dert& I �f =e' ----- 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__2---A. :_.X_C/ Lz, F Test Pit No. 2-------------___minutes per inch Depth of Test Pit.................... Depth to ground water_-_-._________--_____-_- f� -••-• -- -- -- D �, r Description of Soil------------------- -- -- '' --- -•.t, ;,' -' -` - '"':--------------X. ----6--------------- w Y ________________________________________________________________________________________________________________________________________________________________________________________________________ V .Nature of Repairs or Alterations—Answer when applicable----------------------------------------________________________________________________________. ------==----------------------•-----•------•----------------•------•-----•------•------------------------------•----------------------•--------•----------•---------------------------------------- . Agreement: The undersigned agrees to install the aforedeseribe'd 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 ben tss d by the boar of health 1l 11 � � .:� ' �'/ �(S Date Application Approved By..... �'�.� - ° - ,t `� r ,. :.- ; , --� � ,�"' Date Application Disapproved for the following reasons----------------•-----------V-----------------------------------------------------•-- ••----•----•--•----•- ---•-•-•----------------------------------•-•------------•••••--••------•------••--•---•-•-••---•-------•I--•--•-•------------------------------------------------------------------------•-------------- Date' PermitNo......................................................... Issued----------------_--- ------------------•--------------- Date THE COMMONWEALTH OF'MASSACHUSETTS BOARD OF HEALTH J..." „a.........OF......;Z_ �................... (nnrtif iratle of Cn to r i�tnrr THIS IS TO,., ERTIFY That the I .dividual Sewage Dis osal System constructed ( r RepairedVi ( ) Installer P - at °. `a' f -------------- has been instalfed in accordance with thi provisions of Article XI of The Mate Sanitary Code as described in the application for Disposal Works Construction Permit No----- )11. -....................... M K ------ dated �--- ----------=------- 'THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT ON SATISFACTORY, DATE,,._.- ---.------•------•--•�--��-.................................. Inspector------------------C----•--• = THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH < 1 OF.:......-.�s.y-.o•.,,..`y .1=-4.-"'-Li•!'s_S" '.... --. avk",............... n No. i --•---- FEE----'s +_........ 13inpooa19 orko Towitrurtion Vrrntit Permission is hereby granted___.. �'.r � '- ___.__ .x- !.-fr ,.. x : `:_ - to Construct (4,.T)r'6r Repair ( ) an Individual Sewage Disposal System,,,_- ..-,. , at 0 ( '. -------------------------- Street as showti on the application•.for.Disposal Works Construction Permit No sr 4 ..... Dated____ ........... ' -- - . Board of I-Iealtl • DATE: = --=----------------------------------------•--•------- FORM 1255 HOBBS & WARREN. INC.. 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