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Home My WebLink About0083 MEGAN ROAD - Health (2) tzo Flyarmis 0 RNSTABLEB_ TOWN OF A LOCATION �� f�f�� R OA D SEWAGE#,;,2a V`iLL-rkGE /� %1 j'I//'J/% ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. W11-4.114-1'4 QIVXI�e 2Z5 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching ci Feet FURNISHED BY � i f No...... F�>a.... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE �� .......................OF..... .............................. --- ......----------------......------... Appliration for Uhivo,sal Works To strurtion Pumit plication is hereby made for a Permit to Construct ( i}-ar-"Repair ( ) an Individual Sewage Disposal System at/�, .............. .... .. ............................. Location-Address or Lot No --------•---• --------•...--------- ............. . .... .......... -----•------.............................. � •---••--•-----•-----•--- w Owner Address ,-1 ............. ----------------•---•-------------••-- ------••----------------------------------------•-------------------��'a Installer Address S Q Type of Building Size Lot---- ___._�................. q. feet Dwelling—No. of Bedrooms....:___' ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -__________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures --------•-----------------••--------•-••------------•---•----------•-•-----••----.......•--------•------•----•-----------.....-------•••--.......---- wPDesign Flow............................................gallons er erson er da Total dail flow_____--•-•---_--____-___--••-. P P Y• Y --------------------------------------------gallons. WSeptic Tank—Liquid capacit/2 allons Length................ Width................ Diameter---------------- Depth-_-..__-__-__--- x Disposal Trench f—/No. .............. Width-__-__ ----------- Total Le th _......__.._.._.. Total leaching area--------------------sq. ft. Other Distribution box Dosing --sq. tt. z Seepage Pit No. ( ) eter....____ ( ) n t____________________ Total leachingarea_____...._______ aPercolation Test Results Performed by.......................................................................... Date---•------•--------------•-•------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.---_---___-_________--. ftq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-__--____-__-_..-_._._. -------------------------- ----------------------------------------------------•--------------------------------- O Description of Soil...._.._'_ --------- -----••-•-•-•-••-------•••-•-•-••----------••••-------...----------------------------------------- x c., ----------------------------------------------------------------••---• ..........--••---•----•--••-••--------•--•-------•••--•--------•-------•--•••-•------•-•--•••-----------•-•-------•------------ w VNature 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 been issue the.boa f health. Sig d__� � .................... ------------ �' Date � Application Approved By � �� 'il . -------------------- ---- f Application Disapproved for the following reasons_____________ 7J to �- -----•-•------------•--•----------•--••-------•--•--------•-�----•------------Date --•---------- ----•-........--••--•-------------•------------•--------•--------•-------•---------•--......••---------••-----•-•••-----•-•-•------------•-••••--------•--------•---•------_--------•-............... Permit No......................................................... Issued.......4, s" �.%` Date No...... _- Fix.. ._. THE COMMONWEALTH OF MASSACHUSETTS BOARD ® H EA "......-----OF..... .............................. Appliration for Diopolial Works Tonitrnrtion Prrntit Application is hereby made for a,.:Permit to Construct ( 4---6r'F2epair ( ) an Individual Sewage Disposal System at:o� •Location:-Address C/�s � _ --------------------------•'-•-----------.or Lot No. � ---'---•------------•----•-•--------- ------ ----- • --•-•---•--•-••----•--•----•-••------------------ Owner Address a ••-----•---- `.......................................... .......... ............................ ...............................----------------------------- Installer Address d Type of Building Size Lot..__ a._Sq. feet Dwelling—No. of Bedrooms________ _ -__________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ------------••••-•-----••••-----•---•-•--•-•-•••-•••---•-----------••••-•••-••-•--•---- -----------------•-----------------•-----•------------ W Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit� allons Length................ Width---------------- Diameter.----................ Depth--------------- x Disposal Trench—No_ ________________ __ Widt _______ Total Le h ____.._.______.__ Total leaching area--------------------sq. ft. Seepage Pit No-�__--- r._ D v in et____________________ 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........................ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descriptionof Soil.------��¢} . ••-••_..... --------------------------------------------------------------------------------------------------- U -•--••••••----------------••-•••-•---------------•••----------•••-•-- ---------------••--------------------------------------------------------------------------------------------------------- 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been — issue y the boa f health Sig d a -•------- ------p/�---•/--•---•-----------•----•-•-------- / Date Application Approved By.--.,..-. -------------------- --'-- �l -.7. --- Date Application Disapproved for the following reasons:_..--•-------------•-------•-----------•----•--------••-•--•------------•--••-•------•---•-••••--•---------•-•-' •-•----•----------------------•-•---•-------•-•-•-•-•••--•---•----••-••-----'-•-•--•-...._..--••-•----••--•----•••-•------------•-•-••-•--._.--•--------------------------------•-••••---•............. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS .�` BOARD OF�HEA ..........................................OF. ..................................................................- tlrrtifirate of (P�omplittnrr Y THIS IS TO RTIFY,,, h lndivi Swage Disposal System constructed ( �r Repaired ( ) b �-- rr�� .� Installer / •-----_____-- at................................... � - G �d.� ; ---- `� .-1-,1 --------- �;,� - -`' -----' --••----•••-•••••----- has been installed in accordance with the provisions of Article XI of The State Sanitary Code s described in the application for Disposal Works Construction Permit No..... ------- _ _ ___________ dated_._>, __/. THE ISSUANCE OF THIS CERTIFICAT E SMALL NOT BE CONSTRUED AS A GUARANT EE THAT TIME SYSTEM WI 6 FUNCTION SATISFACTORY.D ---------------��.-- ---•----------•---- ATEP-�- �� Inspector THE COMMONWEALTH OF MASSACHUSETTS B_.OARDtF HEALT -F. / ..........................................OF............................------------....... No....... FEE_ V �• •'" . orlm or str ion rrmit Permission is hereby granted _------•-_�---•-- >--•--•••••••---•••- to-Constr t ( o j;�pai ( ) an ndividual Sewag isposal ystem atNo. - ------------------------------------- ---- ---------------------------------------------------- - ---- ------------------- ' Street �*+ as shown on the appli tion for Disposal Works.Construction Pe ' No:_____. :___ _ ID t d__' :- {` __ ----•--.- d of Health jw+ DATE........ --• \ FORM 1255 HO BS & AR N• INC.. PUBLISHERS.