The URL can be used to link to this page

Home My WebLink About0129 MEGAN ROAD - Health (2) z9 fiN gun mod, No... -- � L Fes$.. ................ THE COMMONWEALTH OF MASSACHUSETTS •2� BOARD OF HEALTH (� OF................ 1ST ►.................................................. .�pphratiun -fur Uiupuuttl Work Cnunutrurtiun Permit I App ication is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at .3 , ------- ------- V ° Locati Addres or Lot No. w a. Address staller Address yy Q Type of Building Size Lot_.l_d___`' ---Sq. feet U Dwelling-No. of Bedrooms------------__________________________------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ____._.__ Q � �r.� ---- -------- W Design Flow-_ _____•______________dam------ _,gallons per person per day. Total daily flow____________ra -----------gallons. WSeptic Tank,�Liquid capacity/ -gallons Length................ Width................ Diameter---------------- Depth--------------- x Disposal Trench—No_ ____________________ Width______ ___ _ _____ of "h -_ ._.-�ta�llching area.-_--.- ..__-.-__--_sq. ft. Seepage Pit No.___/............. Diameter _ __ pth . ___ aching area_____.._______.__sq. ft. z Other Distribution box ( ) Dos' tank ( ) aPercolation Test Results Performed by-------- ---------------------------------------------------------------- Date-----•-••----------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..... .................. f14 Test Pit No. 2................min tes per inch Depth of Test Pit.................... Depth to ground water r+ --- -------- Description of Soil.._____ - o x U ------------------------------------------------------------------------•-------------------------------------------------•--------------------------------------------------------------------------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------._.___----_-._... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis 11 System in accordance with the provisions of Article \I of the State Sanitary Code—T dersigned th grees not to xe 21 stem in operation until a Certificate of Compliance has been-" e ' e board alt t/ ,✓ `�`�� Signed/ -- --- Date Application Approved By------ __. __ _ ZS ate Application Disapproved for the following reasons-............................................ ••------••-----••-......----------------------•----•...-•••••..... --••--•-•----------------•-----•-----------------•-------------------•-•-------------•--------•---------- Date PermitNo......................................................... Issued........................................................ Date ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .... .... OF...................WMNSTABLE............................... Appliration -for lliivoiial WOrk Tiltuarurtion Pprutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at'd W -4 ------------------------------7- -----------I—------- ------ . .. ....4"fe-1411%--- --------------- Locatya Addre or Lot No. ... ......... .................................................................................................. Address 4.......... - --------- ................................................................................................. nstaller Address Type of Buildi"`X Size Lot/0, .4��_.Sq. feet U Dwelling V��o. of Bedrooms.--. ...........---1--------------------Expansion Attic Garbage Grinder ( ) Other T_ pe of. Building ---------------------------- No. of persons.--___-_---_______---____.__ Showers Cafeteria ( ) ` /y Other fixtures ---- ------------------------------------------- --------------------------------------------------------------------- ' .............. on per. day. Total daily flow----._---_-- ......_..gallons. Design Flow......... 4.15*7.. Mons per pers ------------4�J. P4 Septic Tank(—Liquid capacity allons Length..._..:_..___... Width................ Diameter_---_.._'_.--:_- Depth._-._--.-..--_. x Disposal Trench—No. ...,............... Width-- --- - ----- of h"_ 7-------- ta - aching area--------_---- -----sq. ft. W. D t ........ eachingarea------- ----------sq. ft. t Diameter. . .- _... . 'U .. I f(Seepage Pi No.---/------------- - pth' Z in 1�,.� ---------0- V I Dos' ,stank 14 Other Distribution box Percolation Test`Results Perfolmed by--------------------- ----------------------------------------------------- Date........----- -------------------------- Test Pit No.'l................minutesp6rinch, Depth of Test Pit--._______________-- Depth to ground water...--_----.---..-.-.--. L=, Test Pit No. 2................min tes per inch Depth of Test Pit--------------------- Depth to ground water--.--.---_------------- P41 1........ I------------ ..... ---------- ..... .............................................. ................ 0 . .. ... . .. --- Description of Soil_._---- .... ---------------------------------------------------------------- U ............................... ................... ........................................................................................ ----------------------------• -------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------------------I----------------------------------------------------- U Nature of Repairs or Alterations—Answer'when applicable-----------j----------------------------------------------------------------------- .............. -------------------------------------- ----------------------------------------------------- ---------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis jal System in accordance with the provisions of Article XI of the State Sanitary Code— T - enersigned rth gtees not to, I lljgsystem in operation until a Certificate of Compliance has b e vAhe boar alt 7 1-*2 Signe ---- -------- -- ----------------------- ----------------- .... .... ......... .--------------- Dal 0,/; , Application Approved By----- - - --- ----- ---- - - -- ZS_ ate Application Disapproved for the following reasons:--------------------------------------------7......................................................... -----------------------------------------............................................................................-------------------------------------------------------------------------------- 11ate Permit No._......................... . .. ...... ............................... Issued.--- ............ Da e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ....�".-Y...B.ARN.STABLE .. ............ .......I............................................ OC F$, T��e Individu Sewa ge Disposal System constructed 'or Repaired T IS T by..... -----------------------------------------------------------------------I............... .... ......tar-.... Installer at-------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_______----------- ---------------------- dated........__......__..-___...__..__.___........... THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------- - Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................OF............... E............................... No........... FEE101.el.............. Bi-ri:Vviial Morkii C11omitrurtion urrmit I." Permission-isher6by granted---------------------------------------------------------------------------------------------------------------------------------------------- tcf*C6ti§tf!Rt or Repair an Individual Sewage Disposal System at .................................................................................. N------------------Stre- et--------------------------------------------*-------------------------- as shown on the ap plication for Disposal Works Construction Permit No_____________________ Dated-_..__-....__-_.__.___-_._._........._. -------------------------------------------------------- ................................................ DATE------- --- -- -------- .......................... Board of Health FORM 125 Hoa S & REN. INC.. PUBLISHERS