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Home My WebLink About0204 MEGAN ROAD - Health (2) agFimim:... .... �..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2�( � t1►�L..................OF........... . -- . .......... . .................... Appli.ration for Bhip anal Our' � Tvm urfivn Prruat Disposal � made for a Permit to Construct Or Repair an Individual Sewage Dis Application is hereby ( ) p ( ) g p System - ---%- ........ � � � -� � � .... • i SI s ��ca�` ddress �— or Lot . Owner • ddress ......... •........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ______________ d .......... .. W Design Flow......................a1� allons per person per day. Total daily flow._._.___.__.___.__r2-_...................gallons. WSeptic Tank Liquid capacity___._ _ allons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......../----------- Diameter.................... Depth below inlet.................... Total leac ' r ...............sq:ft. Z Other Distribution box ( ) Dosing tank ( ) �l� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--•-___•______-_______- O Description of Soil............................ _G :. x --••.........................•------....-----•------------•--••-•-•-----•-•-----••-•----------•-••---------•--------•----...--•-•---------------•---------•------•------•-•--••--••--••----............. 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the boar of health. Signe ......... ---------------•---- Date Application Approved By........ �............ .........••...... Application Disapproved or the followingreasons:.......................... Dat ...........................................•...................................................................................•................................................----•--••-•------------- Permit No......................................................... Issued...... � �, ._.....Date--....- 4_61a/ 40 NO... ..., Fizx.................::.......... THE COMMONWEALTH OF MASSACHUSETTS BOA D.- OF' HEALTH � OF......... ................. Apphration for r Chas a`tr i umit Application is hereby made for a Permit to Construct ( ) or Repair ( `.) an Individual Sewage Disposal system t -•• ••-•- .� 743 . . ddress " { _,�/-.ly-^�'"-`""''� "' or Lot N '' Owner�' ddress W , Installer Address UType of Building, Size Lot.............................Sq. feet Dwelling No. of Bedrooms................. ... .....__Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of `Persons -__---__ _______ Showers — a YP g ------------------- - ----p ------ ( ) Cafeteria ( ) Other fixtures ----------------------------------------------- W Design Flow.':, �' allons per person per day. Total daily flow. ! gallons. WSeptic Tank Liquid capacity allons Length___'........... Width________________ Diameter_...__________. Depth................ x Disposal Trench No ........... Width.................... Total Length.................... Total leaching area......_.............sq. ft. 3 Seepage Pit No. .... ...:...... Diameter _-____•___- --,__ Depth below inlet..................... Tptal leac gar sq. ft. Z Other Distribution box ( ) Dosing tank ( ) t ""IP `� " aPercolation Test Results Performed bY......................................------------------------ -----: Date........................................ a Test Pit No. L_______________minutes per inch Depth of, Test Pit-_...........__.._.. Depth to ground water........................ Gc, Test Pit No. 2................minutes per inch Depth of"Test Pit.._____...._....._.. Depth to ground water...--__________-_._-_.__ Q+' ------... ------------------------ O Description of Soil . -- U .............................................. .............................................-••••----•--•-•- --------------------------.....•--•--------.....••-•••-- x 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 undersigne(V irther agrees not'to place the system in operation until a Certificate of Compliance has been • ued by the boat..4 of health. Signe ---- •--- --•-- -- .:, Date Application Approved B fw•-r• Dat Application Disapproved,for the following reasons:............... '............................................................................ -......... ...----- s Date Permit No -- -- IssuedyA'fDat •�+ THE COMMONWEALTH OF MASSACHUSETTS BOARD O . HEALTH.' a � .. Tntifirati of T,ampliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by - ------- -------------• ---•--------------..... '� " Installer at. - RJR ....... - ........... --------------.................................. has been .installed in accordancewith the provisions of Article J.T Sanitary d as descri ed in the appliapplication for Disposal Works Construction Permit No_________________ ___ _i� dated--- cation ;_. : __ ____, ,, ____-_-- s+` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A G RANTEE THAT THE SYSTEM MILL UNCT N SATISFACTORY. , DATE.... ... ( -----••-- •---•-•-•-----...... Ins ector--•. ......... l P THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE H ....:.OF....... . . .... ......... -- FEE s No.... - __ : K Permission is hereby granted - -`-•--- •-••--•-•-•-....i••............. ..•_.... -----•----.....•--- ;{ to Cons u ( or Repair ( . ) an Individual; ew e'Dispo System -• -- st t as shown op the application for Disposal Works Construction Per No.-_._ �- ated__ .._+ ..... - J// --• ...................................... •-• - •- •• --- - ............. DATE--•-� / - . 7 •----- --------------------- Board of ealth _ FOR TA 1255 14OBB 3y/jW�ARRRE.N, )NC. P BLI E �,y► a f - �oF tH a TOWN OF BARNSTABLE ♦ 0 e BARNSTABLE, 39.0 Board of Healthpp i639. `�0 0 MPY�' FROM THE OFFICEOF t ' a ti