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Home My WebLink About0075 MEGAN ROAD - Health (2) H'Ygnn)5 0� 9 �— �r. S3 THE COMMONWEALTH OF MASSACHUSETTS -" EI O A R D OF HE -T OF.... ......... ....................................-- App iratinn -for Riipagal Works Tonotrnrtion Vrrmit Application is hereby made for a Permit to Construct or ( ) an Individual Sewage Di=p as, System at:. / � � 9 ocation-Add s or Lot No. v! -------------------- ...............................--••------•-••--•...............................Address ' ---•....--••---- r a COG /2f Installer Address dType 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 ._tures ._ ------------ W . Design Flow_______________`��'� __._______ . ions per person per day. Total daily flow--:----__-________--"_--_--_-_-_--.----.....gallons. 71 WSeptic Tank—Liquid capaci --___..-__ allons Length................ Width-_-_ ---------- Diameter------. ---.--_- Depth...._-_._.__... x Disposal Trench—No:.,4r ,elp_:. i i-------------------- Total Length----------_------- Total leaching area--------_-----------sq. ft. Seepage Pit No_____________________ Di eter_-_-__-_-_.__-__-._- Depth below inlet.................... Total leaching area------------------ST it. z Other Distribution box ( ) Dosing tank ( ) — ,s� •, /�G/?�� Percolation Test Results Performed bY-------------------------------------------------------------------------- Date_.------__------------------------------ aTest Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water....----.-._--_.--_----- fi Test Pit No. 2----------------minutes per inch Depth of Test Pit._._ _.______ Depth to ground water_---..__.----___------.. 04 --- ----------_--------- --•------•......................................................... O Description of Soil - 0� ------------------------------------------------------------------------------------------------------------- x _W ---------------- ------.._--. -----------------------•------------------------------------------•--- -----------------------------------------•----•------------•--------••------------- V 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 NI of the State Sanitary Code—The unolersigned furtl agrees not to place the system in operation until a Certificate of Compliance has bee ssu b board of &he S' ned�._ ---------------------------------- ate --•-------------� ------------------•-•- -------•--------- -----/ � �D � Application Approved BY at Application Disapproved for the following reasons:-............................................................................................................... --•-•---•-----------------------------------•-------------------------------------------------•------------•--------••---------------------------------•--------------- --------------------•--------- Date Permit No.---------••--••-•••••••--••-----•-•---•---•-•-----_..... Issued-•••--•• • • �.--- Dat ----------------------------=------------------------------------------------ No.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT_ Joil- ..... ...I.... OF....fe................................................................................ Application -for Miipooal Works Tows1rurtion Pprutit Application is hereby made fora Permit to Construct or Repair an Individual Sewage DispTl System at* ................----------- ...... ........................ ..................... .............................................................6............................... Location-Add is"" 7, or Lot No. ............ .................................................... 0 Address 2. -------------------- Installer Address Type of Building Size.Lot-___' :_ '----Sq. feet Dwelling—No. of Bedrooms.-_ ----------------------•---_--_-__-Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons_..............._...........Showers Cafeteria ( ) Otherfixtures ----- ........................ ------------------------------------------------------------------------------------------------------------------- Design Flow....... .................. ............gallons. �;............,�allons per person per day. Total daily flow............. Ri Septic Tank—Liquid capacie�tf!�`� -"",,Ions Length________________ Width-..-_-.-...._.. Diameter_--.-_:.-.----_ Depth---------------- Disposal Trench—No ��-,: W0,0------------- 1 ------- Total Length..............._._.. Total leaching area--------------- -----sq. f t. Seepage Pit No_____________________ DiqAet. , er.................... Depth below inlet______-_____-__._... Total leaching area------------------sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by.----------------------------------------------........................... Date------------------------------------ Test Pit No. I.............:_.minutes per inch Depth of Test Pit.-------:_--__-__-. Depth to ground water......---------.---...-. Test Pit No. 2----------------minutes per inch Depth of Test Pit----- -1----------- Depth to ground water--------- --- ------ --------------/9--------------------------------------------- ----------------I.................................................................. 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 Code—The uladersigned furt, r, agrees not to place the system in operation until a Certificate of Compliance has bee,rlh,ssued by,-We board of heth, �v ---- ------ ..............Sj ned-.....-n----------------------------------------------------------- ------------------ Jg / .1 Date Application Approved By.........(;,f-------- . ...................................................... ;�Kt-e Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo-------------_------------_........................... Issued---------------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETT 14- BOARD H E A L T+47 „may OF................................................ .......................................................................... OWrtifirate of Tilutphattre THI5,�,S-TO CERTIFY, IndiviX1, Sewage Disposal System constructed or Repaired, b ........... o y ........ .....................................................................--------------------------------------------------------------------------------- ............ Installer at--------------------------------------------------------------------------------- Q_11---------- ------------I------I------------,-------------------------------------------------- has been installed in accordance with the provisions of Article 1, h9 State Sanitary Code a d 'bed the of es �pe I application for Disposal Works Construction Permit No__________________ - -- ---------- dated_._._._. .......... . ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COk7ST . E AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I _. DATE-------------�7 Inspector---------- ........................................................................ ......3-zV- 27 ------------------ 6� THE COMMONWEALTH OF MASSACHUSETT94 7 BOARD OF HEALTh ...................................OF.... .. .................................. ................................... t" FEE................... 171 Permission is h_hWAy granted----------f I------------- ...................................................................... ,� to Constructo(_'�Tor Rep;i lividoal Sewaje. 9isp&al Sysfk at No...... - -------------------- - ---- ----------------------------------7 ------------------- Street 11 �0 as shown on the a V / , m,,:4 j -tjit N --- Dated-AK" -4. ..... ---------- application for Disposal Works Construction m .............. .. .................... Board of Health /101 DATE....... ----- ------- . -------------I--------- FORM 1255. HOB13S & W RREN. INC.. PUBLISHERS