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Home My WebLink About0091 MEGAN ROAD - Health pv� 4t�( - aka- asp No.. t ® F :..?. ...... THE COMMONWEALTH OF MASSACHUSETTS �. �E®AR® QF HEALTH ....oF----- -- ----- ------------------ --------------------------------------- ------------ ,��u�t�t�a� for �t��n��t� Warks Tinuitru.ctiun Vrrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System a ?CO`�I I,� '►• ... ---------------------- , --Location:- G..... cy.. wne Address ......•.................... Installer Address �J/V/ d Type of Building Size Lot-__--'`-.--r-. Sq. feet Dwelling—No. of Bedrooms......__..Z..........................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g -----------------------•-•-- P' ( ) •— Cafeteria ( ) dOther fixtures --------------------------------------------------------------•------------------------------------•---------.----- ------ W Design Flow...................................... lions per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity �� . gallons capacityLength---------------- Width---------------- Diameter-----------..... Depth---------------- x Disposal Trench—No_____________ __ Width-------------------- Total Len 1 _ �otal leaching area--------------------sq. ft. ___ Seepage Pit No/ ._ eter Depth bel lal leaching area sq. ft. Other Distribution box Dosing tank W Percolation Test Results Performed by-------------------------------------------------------------------------- Date------•--------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_____________________--. �14 Test Pit No. 2................minutes per inch Depth of Test P" --------- Depth to ground water_______________________. O Description of Soil---- _. ._ 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 XI of the State Sanitary Code— The ndersigned f ther agrees not to place the s stem in operation until a Certificate of Compliance has bee is ue b the boa fRMth. :I e Signed-- -• ....... --------------------•-•-------•------- - -----------•-••-•---- ----- Date Application Approved BY---------- --•. •.. Z ---- ---------------- ---v �� Application Disapproved for the following reasons:--••-----•---------------- --•-•-•-•----•-•---------------------•-•-•------------------------------------------- ----•-•'-----•-------•--•--•--------•----........'•--•------•--•------••-------••---•------------•••••.....-••--------------•-----------------•-----•------------------••-------------------------------- Date . PermitNo......................................................... Issued........................................................ Date No—air......... .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALIH ........OF. ........... ............ Application is hereby made for,a Permit to Construct (L—y-'or"Repair an Individual--,Sewa9 e Disposal . System at ,1,2 -------- . ................ .......................... Location-Address------------- --------------- .............................................................................. ................ ...................................................................................... . owne Address ................................................... ..... ............. .................................................................................................. Installer Address U Type of Building -2- Size Lot_._....__....................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder P4 Other—Type of Building ---------------------------- No. of persons..:__._............._....... Showerg Cafeteria P4Other fixtures .............................................................................. .............................................................-------- Design Flow........................... Mons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacit)e...........gallons Length---------------- Width----------- .... Diameter----- ---------- Depth---------------- .Disposal Trench—No........... Width.............___.... Total Len g otaIleaching area--------------------sq. f t. Seepage Pit N0"1f1-- lameter.................... Depth belvw_loin ....... Total leaching are�L------------------sq. f t.�et... 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------------------ GL, Test Pit No. 2................minutes per inch Depth off Test Pit_.............._.... Depth to ground water----_-_--_----__.._-._-. ........... P4 . .......................... --------------------------------- 0 --------------- ------ ........... a Z ---------------------------- ;-------------- Description of Soil---.,, ------ ------------- ------------------------------------------------------------- ----------*--------------------------*--------------- U .....................I...................................................................................................I---------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of,Repair o 'Alterqtions 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 nde.rsigtied f rther agr.ees not to place the system in operation until a: Certificate of Compliance has bee Issue the boa of ealth. ..,.�?Signed_ ...................... - -------------------- ..... ------------------------- ------------- Date/7 Application Approved .By.... ... . ------ -;e tlas . .................. ... Application Disapproved for the following reasons:............................................................................................................... ..................................................................................------6............................................................................................................. Date Permit.No......................................................... Issued.,.................... ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .................OF..................................................................................... %.'Wrtifiratr of TwOurphaurr THIS F Y, Th e Indi * all Sewa e Disposal System constructed (__T or Repaired by............... --------------------------_ ./Z-------------_-------------_ --------------------------------------------- ------- at........................ Installer ------------------------------- ................ --------------_---------- . � i 7 , ..................... ................... ---------------- has been installed in accordance with tp?provisions of Article XI of The State Sanitary Code escrj� d e as s I i in4he -application for Disposal Works Construction Permit No................ dated..-_-.- )X/---- 7 THE ISSUANCE OETHIS CERTIFICATE SHALL NOT BE CONSTRUE® As I dET-HAT THE SYSTEM WILL UN IONSS#41SFACTORY. DATE--------------- ....... ----------------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,,0F HEA ................. r,,,----------------------------------------------------------------------------------- No.....s 31 0 FEE........................ Permission is hereby granted......... ---------------- ----------------------------- to Construct oj�Repair an Individual S sal S atNo..... ... .o------ .... ...................Z;;,.................................... .... :yS%-------------------------------- Streei --------- as shown on the application for Disposal Works Constructi ern-lit Dated - --------- .............. ....... �o P14� .. - - - -------- 8oar�d Hof • DATE_-— ...... --- -Z-7---------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS