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Home My WebLink About0266 MEGAN ROAD - Health (2) 266 l� EG�N a9�- a �s Nya nn is No..--... .............. FER ..... THE COMMONWEALTH OF�M{ASSACHUSEETTS B®AR® r fl�/`YL�f-1 `. .. OF....... ... 1�!}d ............................... 6 1 Appliration for Bigp wd orho Tomitr ion pr uttt Application is hereby made for a Permit to Construct (/1-or Repair ( ) an Individual Sewage Disposal Sy t: - ...... r t N , 2 -� .......... -... _. ._ .... ..... / ..........._... ..........---- -------- wner s o . ..--....... .......................... . ... o ...0- -- Address ... -- --..-....- --- , -• -- ------. AZ.. Installer Address Type of Buildi � Size Lot... l �....Sq. feet aDwelling�No. of Bedrooms..........._Z......................Expansion Attic .( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .__. ---I-------•-----------------------------------------------------------------•-----_--- •�- —•! Design Flow._........___ _:_.___..__gallons per person per day. Total daily flow........=_�_-!__.....•........gallons. p . Septic TankY Liquid capacity/.e��_gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench— 0..................... width---_.___-___ _ of Len Total leaching area....................sq. ft. x � f� � Seepage Pit No____________________ Diameter_ ._.__._.__.____. eptl e ow in et__________......._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......... _........... prq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___ __f____-_______- 4O ----------------------------------- .................................. o --•---------=...•---••-- ......-• . --•-•--------escrpton o - -- . x W ---------------------•-•----------•---------------------------------------------------------....•------•-•--••-••------------•-----•-•••--•-••••-••-------- ........................................... U Nature of Repairs or Alterations—Answer when applicable....................................................•_.____.._______.______.__......._......___. --------•--------------------------------------------•------------------------------...---••-------•----•-------•------•----------••-------------------------------....-•._•---.........--------........ Agreement: The undersigned agrees to install the aforedescribed Tndividual 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 jOueSd by the board of health. Signed ��` Date ApplicationApproved By..... ... .......... ----• . . .......... ------------- --------------------------------------- Date Application Disapproved for the following reasons________________________-- ------------------------------------------------ ._.___._...... ........................•--------------------------------•-••-------•-----•---------•------------------....-------------•----•--•-•-•••-••••-•-•...._.. -------------- { � - -••�--�-.-�-Date Permit No........................................................ Issued--.¢.. �/ .... B l Date ' /"'� ��••� Fug .............. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH OF Appliration for Disposat Works Tonstrndion Vamit , Application is hereby.made for a Permit to Construct ( or Repair ( ) an Individual Sewage'Disposal ..._ ... ....... .. . . .... Ad s o No. ner *. • ..........................•_.Address . , ._... ----------------- -------------- •-.------..............---_:_.._._y -- Installer Address ff "T •.W Q Type of Build Size Lot-__,/ ... ....Sq. feet U Dwelling No. of Bedrooms:_............�.._..4......--------------Expansion Attic ( ) Garbage Grinder ( ) 'P-I- Other—T e of Building No. of ersons____________________________ Showers — Cafeteria a' Other fixtures _. -___-___. _ ...... W Design Flow:_.......... ,_ _.-__gallons per person per day. Total daily flow.___--- ... .._....__gallons. WSeptic Tank Liquid capacity/ wgallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No--•------------------ W> th___ o Len 1 _ Total leachin area...........__._.__._s . ft. P g q 3 Seepage Pit No----- ------------ Diameters- Dept1 'Cie ow m et ` Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed bY----•--.....----•-•-•---------------------•--.-............. ------------- Date a ._. Test Pit No. 1................minutes per inch Depth of Test Pit......... Depth to ground water....................... . f= Test Pit No. 2................minutes per inch Depth of' Test Pit...._ ....._......._ Depth to ground water ......... a --- .-•------ = , ".Description of Soil.__._._..." ..._..... `'fir x W --------------------------=---••......------------------------•--------------------------......-------•------------------------------------------------------------------------------------------------ Zxj 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 board of health. ,. 7 Signe - ............. c Date Application Approved BY--- --- . ....... -- -- - ............. .........---•------- ------------------ . y Date Application Disapproved for the following reasons:----•----------------•----•- ---•----•--•----•----------•---------•----------------------------------------- ........................................................................................................................................................................................................ {r; Date PermitNo............ •...... ................• Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 9T . HEALTH �* „ ............OF..::. . : :. ......... (9rdif rear ,af Conip4aurr THIS.IS TO CER FY, T the Ind' idual Sewage Disposal System constructed ( or Repaired ( ) by " •-- ,� 1'.��•,w�.�=:""`. -._... --------- .. _--- - ------------------------------------------- has been installed in accordance with t►ffe" r�ovi�ons « .p of Article.. I The State Sanitary Code as descr bed 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,FtDNCTION SATISFACTORY. DATE...................: __________________ Inspector....:......••--....----• :.._.. ....._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT w .....OF....: .1� ��' ........ No:. • ~� FEE. " �i �rla 1 nr� fit n anti# XY s` Permission ,}s, ereby granted...._ to Construct or R pair ,, ) an Individual e Disp ystem l 1 V . tr as shown on the application for Disposal Works Construction P No...... .___ d...� _ . ......... ,. p ............. o9rd of ealth DATE................................•---•---••-•----•...............__________----- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - a _ �,� -� �� > as � �r u - r ' r - 'sa... '�' ,.. � e . - - Vs. A - f -•-t. '!n Zi. Imo' '�Y- $�-i' 1. Y _ _ _ r' _ T. 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