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Home My WebLink About0351 MEGAN ROAD - Health (2) 35l -_l h 3 o T2i2ii- v Ar v 5 7-/ , 57-i4IYZ r ,Tl mrV Y sm IT /3/3/?ti 7j CoPyOLi,g/-cf /'a3 --7 y`/l�j I v 3y' 3r /—/Ooo CIV >9wr 1- /o 7-0 THE COMMONWEALTH OF MASSACHUSETTS _ BOARD HEALTH Appliraftan -fur Bi-spuuttl Murky Uiitrurfivn Vrrmff pplication is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System : ------- -------'------------------------------------------ ocation.A ess �i or Lot No. ................... ........••---------------•-•---...._.......---•-••----'-'•-----••--..........................--•-- Owner Address Installer Address UType of Buildin� Size Lot____________________ Sq. feet Dwelling=No. of Bedrooms___________________ ____.Expansion Attic ( ) Garbage Grinder ( ) nk Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL4 Other fixtures __.__. x Design Flow ......... .... gall per person per day. Total daily flow...__._ gallons. 9 Septic Tank Liquid capacity __ __g ns Length________________ Width_.___._....._.. Diameter_____.._...___. Depth.__.______._.... W Disposal Trench—No ____________________ Widt i__ __f__--__SN .ength-__--_--____----_-._ Total leaching area.__._.___._.-------sq. ft. x Seepage Pit No________ _____ ____ Diameter ._. DepV below inlet-------------------- Total leaching area.-___.___._--__--sq. ft. Z Other Distribution ox ( ) Dosing tank ( ) Percolation Test Results Performed by--------------------------------------------------------------- -------- Date........-..-.-------_.--------..-------. a. Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_._._-__.-_.-_._-._._..- L14 Test Pit No. 2................minutes per inch Depth of T Pit-------------------- Depth to ground water-_---._..-_.__..-_-_. . a ----•---••--• -------- -------------------------------- --- -•--••._.....-- -•-----.-•--- -.-- - - ------- Description Description of Soil---------------------------------------•---------- '� x W s 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned----- Date Application Approved BY f 4{--�? -•• - D to e Application Disapproved for the following reasons-----------=------------------- ... ... ..................................................... .......................................................... ........................................................... ---------------------------------------------------------------------------------- Date PermitNo--------------.......................................... Issued.---•--•-----------••--------------•--------•----------. Date ----- ----------------- -------- - - - -- - - - --�`-- - - - - - 4 3 THE COMMONWEALTH OF MASSACHUSETTS j BOARD /Q HEAL T H oF.......�/.�+: .: .: .....Y.-.......---............................. Appliration for Biapuiitt1 Workii lattitrurtion 13rrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S stem A y' __ ter_ ,r a i ---- _.. - �x..'1-------- [[ ,x ., •_ ,.� Location•Ad� -w or Lot No. w 1, Owner Address a ` .. vy ----- Installer Address Q Type of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms------------------ Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ------------------------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL4 Other fixtures _______ ____________________ w Design Flow_____________________ ____ _ gall per person per day. Total daily flow.._.._. ��.. _ __ gallons. WSeptic Tank 4Liquid capacity/� a_ s Length................ Width---------------- Diameter--.------------- Depth............... x Disposal Trench—No ____________________ Width._._...•.___._____ffota3 Length._--.._.....__.__._. Total leaching area.-.--._._.---____-_sq. ft. Seepage Pit No-------/___.__._.__ Diameter _42___'.�'�� Dep h.4relow inlet____________________ Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date_..---------------------.-.---_--------. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water---------------------- rX4. Test Pit No. 2----------------minutes per inch Depth of T e't Depth to ground water---------------------- .......................... �;� --- Description of Soil.............................................................. ��r' �._ !'...-.�... - � •- --- --- -;. --- ---.*-` ' - ------------ w UNature 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. _ Signed -- ----------•- . --- ----- 000,_f �` ) Date Application Approved BY ` = = b'"- Application Disapproved for the following reasons--- .•--•--___-•----- ----••-----•---- -L ------ ------/..-f-"----••-•••--------- --•---------•------------------------------------------------•------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH r+: *... .. .. OF........:.... .. .... ...................... Xprrtifiratr�g '`Tompliaurr T f CIS--. CZRTIFY, That the Individual Sewage Disposal System constructed (/,'y or Repaired Y ( ) b rI l l a t -, � �� I talle>f •- -----•--•------------- Or ui w ---------•----•--•--___--•---------•-- has been installed in accordance with the provisions of Article I of Tth tate Sanitary Code as described in the application for Disposal Works Construction Permit No..:-----__?__ 4;�........ dated....�� THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AZRANTEETHAT THE SYSTEM WIL FUNCTIO SA I , CTORY.DATE---...--- ; 2- -•-------••---•--•----•---•---- Inspector------ - -------C.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,,-HEALTH OF te No. ; FEE -- - Dinvo all ,> rkii Tomitrurflit Prrmit�.�,,,,�,,, Permiss.ori re granted----- _al _ _ _" ._ to Construct/( ,} or Repair (, �) an Individual Sewag tsposdl System at No.. ` '' `------------ -= - -_-----•� '� ,,.,�- Street r - --may Street as shown on the application for Disposa�orks Construction Perm No ______________1)ated__._ ..-_#. ..-_____._._______ t.. �" DATE-------------- --------------------------------------------------------------•-- FORM 1255 HOBBS IN WARREN. INC.. PUBLISHERS gar,�i{"r°-�}r:IWsi,.'�{'"� ��*."�'�+`'- _: -- .�«. �" �' �_'.� ,� ' t'--,:�.q;%1 ' `�'"3e jM1 v� p�+�"""�,* '^jys-+ "�° '^ .��_ ►- S�" r+4;..: ra. i 'P9"'T 74rK ..•,k„ r- ,c e�,�:c'�`4 .:G„M1Zs�. mot,-„ram �=s. ��+� �, w�,�,�.°� '� -,�..�,,5�''}. ITA : : T ;-j„- �,, ,,..ua.., .y��,, -��'•' ,-;,+�.., ,;.+�a ,,` P -c ' W- ..."Y` , ' '". •: "`^y, -+ipt�,r.E:pa.? 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