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HomeMy WebLinkAbout0361 MEGAN ROAD - Health 3 � � rn ��� , �{ — � �9D- 1 zd' No.._....��r... --' ( Fxs d..:.U..l.�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH VApplication Iiration for Btu mal Works Tonatrurfa.a unfit is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �� ---•----... �.. ------.....•. .-••-------i..............•-.... .......................�!r� .............------------ Location-AZ, ss or Lot No. ............, =-/� -�....., : r ------------------------------•------ ...............................----- ..K ............................................... Owner Address Installer Address Type of Building .g Size Lot-:__.. �!�®....Sq. feet aDwelling—No. of Bedrooms...$7"_______________________________Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a � Other fixtures ---------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow......... _______gallons per person per day. Total daily flow........3.C�42.......................gallons. WSeptic Tank—Liquid caX0.14._...._..__.gallons Length-------_------- Width................ Diameter------_----__-_ Depth................ x Disposal Trench—No..................... Width-- ____._-_-____-.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..AQ.Q_0------ Diameter____________________ Depth below inlet..........._........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 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........................ a -------••...............•----------...-•-----------------------------------•--.......--•................---•••--•----•---------------------------•-----_----- 0 Description of Soil.................................................................... ------------- --------------------------------.............-------------------------------------------------------------------------------------------------------------------------------------------------------- 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 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. Signed- "'fit z ---- Date Application Approved BY :..._... = --...---•-•....... Date Application Disapproved for the following reasons-----------------------•-----...------...----•-------•--------....-----------•-------- Da .............. -•---•---•-----------------------------------•---.....-----•--------------------•---•--•-•-------------------•-------••-•-•---•--•••------------------------•--••-..... .....•............ .............. Date (� Permit No._._.. d .... ----------------- issued..... .. ..-----•....--•-- ' ��✓ Date r/ i� No................ ��.... F��.%.......'......: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /•!',.lt: .c .---.....0F............44. 1tr;--fi----L--+`� Apphration for Utspviial Wurkfi (futtitrurtivtt Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... �. �' 'i/' e.� ''.* G r /f- .............. 7........................................ .......--•-•......--•---•-••............' Location-Address or Lot No. •----------•- ........ ........................... ._...- '� �•_ Owner Address W .............................................................. rl ----------•--•--•-•........................................ ............................... Installer AddressPQ J d Type of Building Size Lot_..•......................._Sq. feet aDwelling—No. of Bedrooms... .................................Expansion Attic ( ) Garbage Grinder ( ) pi Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ________________ _________________ W Design Flow.......-.;3 !" .................gallons per person per day. Total daily flow____.._....Zd0 ............gallons. WSeptic Tank—Liquid cap cij.�__--___gallons Length................ Width______--_______- Diameter---____.____-•-- Depth............ x Disposal Trench—No..................... Width._••__-..__-_-____.- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-1AOa------ Diameter.................... Depth below 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 Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 •-••-•-----------------•---------------------...._..----•••-•••-••-•----------•-•••--._...................................................................... 0 Description of Soil.......................................................................................................................... v •-•-•----------•----•••----•-•...- -•y•....................................................................................................................•------••-•....---•--•---•--•---------•--•-•--------------•--••......------.............................................. 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed "' �! �*:. Date Application Approved By.�� = ----.---- Date Application Disapproved for the following reasons--------------------------------------•-•------------••---------------.......--------------------.............. ..................•-•--•-•••••--•-------------------••---------•••---•-•---------••-•-•------•...__.......--••----•••------•-------••----•---•---•-•-•-•--•---•----------•--•-•-••----•-----••••••-•••--- Date Permit No. -•.-•---------------•-------_.... Issued... ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................:.....u!. ::.......O F.........�, :I .s................. ........................................... 10.1erfifiratr of Tomplitttta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ---•------------- ---------•-----------------------.............._........... Installer at.............. ... .............'...._ ' =' '' i" ---------- ------------------------------------------•------•-------------------------------- hag 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... f:.l;�.G----_-------•________________ dated................................................ ^ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A CUARAN'TFE THAT THE SYSTEM NV LL F CTI N SATISFACTORY. DATE..... °` ._. ............................ Inspector...:. --•- ......... THE COMMONWEALTH OF MASSACHUSETTS � � BOARD OF HEALTH .......................................... ............................................................. No....... .. ...... • FEE........................ r.: 19isposal Works Tonstrurtion ranfit Permission is hereby granted........ Ar._ !' rt�« �' to Construct (� ) or Repair ( ) an Individual Sewage Disposal System at No....... == =' ..../�._....-.._r ,fir r .>. P f . .! r.....f .._... _ ----- as shown on the application for Disposal Works Construction Permit tNo...:..:�.°�..... Dated.............................�......x......... It, .....................................................•---•---------------•-......................._...._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - �"' C.•e+�F Y�'^y �y���r �s=t,.[.�e s �:. � �.�, "" � 1;�.6.:� e. �' # {Tr}'a i.. r��'- -'.�`�t'C"""VtikL'���gt'S` t.2�*,'�R`N '��:.d� ga""°'�'kx� r��-i�"" -,fr'��'�zC°,�''�"`.iz'` _t"�l,S :'sr .�_.- K,Yr�:A _ ,.tom;•-`t� a�""T,ss�,. `.�t:1t'�"�_'-3'!'r�q+s"r+.�xp �e�'�'��w� . Rt -. 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