The URL can be used to link to this page

Home My WebLink About0180 MEGAN ROAD - Health (2) ��o �� +}`� - aft - Z�z c2 THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HE T --.....:....... OF..... :. ....� .. Appftrtttt,att for 43iopood 10orko (fattotriartiatt Vrruiff Application is hereby made for a Permit to Construct ( " or Repair ( ) an Individual Sewage Disposal 4 System at �•-•-------•- -- •------------•--•---------------------•--. Location- es or Lot No. _ /_ __ O r � _ Address � nstaller Address � d Type of Building Size Lot___ r_ ,_ __-___Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria p' Other fi s --------------------•--------- W Design Flow_____________?___________________gallons per person per day. Total dai flow...........T6-�_-----------------gallons. WSeptic Tank—Liquid capa gallons Length..... ...... Width________________ Diameter---------------- Depth--___-______--. x Disposal Trench—No................. Wi th------------ Total Length ---- Total leaching area--•-•-------------_sq. ft. Seepage Pit No.______ •_ i , et _________ ____ __ Dep• b i Total leaching area-----7— sq. ft. z Other Distributio smg tank ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-----_--__-------------------------_.--- a Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water__-_________________--_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water______________________-. /Descriptio f Soil -- - - - - - -no x - -------- -- - --------•----------- - W ------------------ --------- ------------------------------------------------ --------------------------------------------------- ----------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -------------------------------------------------------------- •------•-----------------------------------------•-----------------------•--•-----•-----••--•---•••-•--•-••----------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposa System in accordance with the provisions of Article XI of the State Sanitary Code—The un rsigned further a snot to p ;I7,' 'l operation until a Certificate of Compliance has bee ss db oard oeh. Signe ,, --- -----------------------— ------------ -- Application Approved BY-• ---• � � ��--7,3_- Application Disapproved for the following reasons__________________________________ -•----------------------•--•-•------.__-_--•---------ate------------- _-----------•-__•--__•-----___•-_-----•-------•----••--•-•-------------------------- __-----•------------•-----------•----••---------------------------•__-•--------------- Date PermitNo......................................................... Issued---------------------- --------------------------------- Date No.... ._,............. ..... a.... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEZ T _ ..................OF..... .. Appliration, far Elisplasal Workii Tuttitrurfiatt Prrutit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal ol System at Z4 < .......... .........Z ................................................................. Location- es or Lot No. Ow r. Address !/` ZZ 'nstaller Address Type of Building Size Lot.... 3r_a- Y Sq. feet Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fi s ---------•---------•----------- -- W Design Flow-------------- ____________________________gallons per person per day. Total daily flow............ G!------------------gallons. WSeptic Tank—Liquid capa gallons Length......(...... Width-------- ------ Diameter-•---- :---- Depth---------------- x Disposal Trench—No.-------------------- W- th... ......... Total Length______________.__._ Total leaching area--------------------sq. ft. Seepage Pit No..______ i met ......... bek i Total leaching area_.____��% sq. ft. Z Other Distributio...... i Percolation Test Results Performed by.......................................................................... Date---------•------------------------------ W a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ -----------------------------------------------------------------------------•-'-------- --------.......................................................... 0 Description of 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 un� rsigned further agrees not to place/,py �m ioperation until a Certificate of Compliance has been fssti d b aboard of th. /Signed,. G� ------•-- l� _ Application Approved BY---` `' 4..i_ --------- ate Application Disapproved for the following reasons------------------•---------------------•-------------------•-------------------------•--------------•----------- Date PermitNo......................................................... Issued........................................................ Date COMMONWEALTH OF MASSACHUSETTS BOARD........... OF..... �,VHEALTH/ ......................0........................... ICErrtif iratr of TainViiatirr THIS IS, CERTIFY hat the dividu Sewa e isposal System constructed ( or Repaired ( ) by � ---------------------------------------------------------- -----------------------' Ins aller at........... -• -•------- 7 has been installed in accordance with the pr------ s 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 CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI:SEACTORY. DATE. = Inspector ----- ----------------•------- E COMMONWEALTH OF MASSACHUSETTS BOARD O EALTH� ...........OF--- ----------- No......................... FEE........................ �rk,� �# �trti� rrntit Permission is here granted-------- •---..--•--- ----------... . -------•-•- .Constru t ( or Repair ( ) an Individual See Di s a1 System at No. Lrl `; ----------- /// Street as shown on the application for Disposal Works Construction Permit N.o� �---___ Dated------------------------------------------ --------------/---4ff: 'ZZ --------------------------- Board of Health DATE-------------------------------------------------------•-•-'•...------------.... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS