HomeMy WebLinkAbout0021 MEGAN ROAD - Health (2) A.
No.2....f ...... F.Es........:....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ® ' HEALTH
............................ OF.............................................................................
Appliratinn for Disposal Works Tonstrnrtion Prrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: 6r ' '"__ z- { �.............................................................r�_ � 6j .
------------•-•--
or
---------•------Location-_ e . . ........................... Lot No.
net Address
W svy'_
Installer Address
d Type of Building Size Lot....�_.. feet
U Dwelling No. of Bedrooms.. ._...Ex Expansion Attic�•-•� g— ------•-- p ( ) Garbage Grinder ( )
pa-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fi tures ------------------------
W Design Flow........... ... .....................gallons per person per day. Total daily flow......___° ___.___.........._...gallons.
WSeptic Tank—Liquid capacitygallons Length................ Width----------...... Diameter---------------- Depth.-.-----_--_.--.
x Disposal Trench—No. .................... Width___._________.__.. To 1 Lengt Tota lea ing area--------------------sq. ft.
JJ - ----
Seepage Pit No........,�....... Diameter._! p el �___ _...... o a e hing 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---__----__-_-__---.---.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............-__--.._.
------- -----••----- ................................................................................................
Descriptionof Soil - -- ----------•--- ----•---•-••-•------••----•-•-•------------------------------••---•--------------•-•-•---------
x
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 bVuied��e board o b th.
Signe _.... ----•--••----
D to
Application Approved By......... ._
Date
Application Disapproved for the following reasons----------------------------- ...-------------------•-•------------•---------••-•----•------•----___--
---•--•••--•--••••-------------••-•••-•••-----------•--•-•---•-•-•••-••----•---•--•••----•-••----•---•----------•--•--•-----------•-------•--•-•--------•-: -----------------------------
Date
Permit No.. _....._. Issued. ------ •-•---
Da e
No.. ...1.6...... FE>a • ......: ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
-......._.............._......O F........................... ......................_...............
A AirFation for Dig as aA Wvoj nn��ratr�i�arn rraati�
Application is hereby made for-,a Permit to Construct ( oTAR ' air ( ) an Individual Sewage Disposal
System at• '2
... --------------------•------- •--- ..-------•--.---- �`��
�s ._--•-• .. ............:
�+ Location- de s 3 .< or Lot No..
am
----------
z r-
`y, wner Address
...................... ..•-•-............. -------------•---•------------------- -----------------------•----------------------------------------•--•------•--------------------
a
1 Installer Address
UType of Building Size Lot.... . ------- q. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( .) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( )
Othertures ......................................................----- .................. --.......-•••••......•-• ----------------------------------------
W Design Flow........... _ ________________________gallons per person per day. Total daily flow......... _ `_ ?........_._.__-------gallons.
WSeptic Tank—Liquid capacity' gallons Length................ Width---------------- Diameter--_-_--._-____ Depth................
x Disposal Trench—No_____________________ Width.................... Yqftl Lengt ---------------- TotaI� ' lea O ing area.._........._..__..sq. ft.
Seepage e Pit No........ :....... Diameter.. �- � 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----__--___--_______---.
G4 Test Pit No. 2................minutes.per inch Depth of Test Pit.................... Depth to ground-water...___-_________-----_-.
a; =
D ,� -. - =
Description,of Soils ' ' t _-- ._-
--------------------------------------------=
x , -----
W .�.
VNature of Repairs or Alterations—'Answer when applicable.------•--------------------------------------------•-.-.--_-.__---.---_---_-_::.:--_-_-___--.
--•--•-----------------------•------------------.-_----•------------•-•--•-------•--------•-------------------------------------•-----------------------------------------------------•=---- ----------
Agreement: r
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 beeg issued the board of 46 th. ;W
Sign
.....................
D to
Application Approved By._-
. --•-••-•....... = �` -----
r /Date
Application Disapproved for the following reasons------------ ------••-•-•.--------•---••••---------------------•---------••-•---------•-----•--••---------------
' Date
Permit No........................................................... Issued.---= `-W7`"-` �"`- -
Date
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD -OF HEALTH,
Tntif irat a of TnntpHatnrr
THIS IS L CERT sY, That-the'Ind- idual Sewage Disposal System constructed ( ;Repaired ( )
by -----------••--............................
Yi staller
at ------ -- -----------•--•-••......----------.---•-- -------
has been installed in accordance with the provisions, of Article XI of The State Sanitary Code S scrib_ed in the
application for Disposal Works Construction Permit, No------------�9_Q............... .dated...... `�,_�,.., �_��•4______.._____..
THE ISSUANCE OF THIS CERTIFICATE %HALL NOT BE CONSTRUED-AS A GU ANTEE THAT THE
SYSTEM WILL.FUNCTION SATISFACTORY. �
DATE. ----------------------------- Inspectors',
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH .
r r .
No.._...... FEE.: •-•-----•...:.-----
• 4 �i.���� nr � � = �#railsn �l�rani�
X .
Permission iss ereby granted--• t« s'f .2 s .-eat
------------•-------
to Cont (,o') or 1pair n,,,( ) andividual Sewage D sposal System
at
Strcet as shown on the application for Disposal Works Construction Permit No.��. ----- Dated____: r`/ �.
.✓ y� �'r � �,,���' B6ard of`FIealtli ---�-•-�
DATE--•-.••/ _Ar / ' ,,
FORM 1255 HoeaS& WARREN. INC.. PUBLISHERS