HomeMy WebLinkAbout0042 MEGAN ROAD - Health 4a M�j°.ut R�ac�
� key - aka -�-3g
r
C� ?
No.. / J �........
THE COMMONWEALTH OF MASSACHUSETTS
Lj BOARD OF HEA TI-
.............. .. ...................OF....
AvOgration -for UWVviittl Workii Tooi#rorfioo Vrrntit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
cat' t�d_imss or Lot No.
_/--- e V, e ...... -----
lip wner Address
Installer Address %�
d Type of Building Size Lot_-_._._.._._I..._______....ziq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- --
W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capac� id
t Ions Length................ Width._•-_-_.-.-.- Diameter_-.--_---.___- Depth----------------
x Disposal Trench—No......... ........... i___---_-'__ Total Len��ggtl'//'����__.___ ___ Total leaching area--------------.-----sq. ft.
Seepage Pit No._....... '�� lcre _._______ Total leaching area._ _.Zsq. 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---------------------
•-------------------- ---------------------•--...-•----.........................................----------------
xDescription of Soil......... /
V .......................................... .......................................................... ------------•------------•--
W -•-----•-------------------------------------------------------------•----------•-•------•----•-------------------------------------•-----•-----•-••----•----•-------------- --•-----------------------
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 beep issued e board oj/ealth. n
Sign _---•-------
a-, Date
Application Approved BY ---- -- -------1� VZo�. l7-
B ate
Application Disapproved for the following reasons:_...------.
--••........................••---•----------------------------------------•--------------------------•------------•--•----••------•---------------- =_--- --- ----
Date
Permit No. Issued--•--_�--
Dace
'Ae
�J ✓ pfdr/
i,00-y' 4"" Fps . .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA T ,�`
sia
Applirat on -fur Diupouttl Workii Tomitrnrtiun Vrrntit
Application is hereby made for a Permit to Construct ( -or Repair ( ) an Individual Sewage Disposal
System at jr
dbm
-------
ocatyo_� Address ------------- -------- -----
w� �f or Lot No. 4 _
` .. 19
Owner � 'W ,�8 � Address
Installer Address
Q Type of Building Size Lot.............. �.............Sq. feet
Dwelling—No. of Bedrooms...._---------------------------------------Expansion Attic Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons-_.._.__-__---_-__---------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- • _
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
P4 Septic Tank—Liquid capacit _fO.° _"�Iilons Length---------------- Width....-...------- Diameter---.------------ Depth--__--__------
W Disposal Trench—No __ Wi I Total Lengthy _ if--------- Total leaching area-._... ____..__...Sq. ft.
� Seepage Pit No.._____._,t d��2t�*�_------- ___ � '"" met____________.__.... .__"Total leaching area3.0_ ---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-.______.____-__-_._-_-
�14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__.__.--______--____.--.
P; " --•- •----------------------------------
---•---•--•---•-••------.-•--•-----------•--•------------
P � ` �"` = -'�°?^ ------••-------------------------•----•-•-------------------•--
D Descri tion of Soil
U ----------------------------------------------- -----------------------------------------------------------------------------------------------=----------------------------------------•--------------
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 beeji issued he board o wealth. 4
Sig --------------------------------
Date
f
te
Application
Approved Bre ,�'� .._.. ! "" = _ '
PP PP y =
Application Disapproved for the following reasons--------=-------'-------- ----------------------- ---•------------------------------------------------------
------••-•-•-•---------•------------•---------------------------------------•-•---------•------------•-----------•-••--•--------•-......•--•-------•---.....-•--•---------------------...--------....•..
Date
PermitNo......................................... Issued-------------------.................................
/ Date
� .� THE COMMONWEALTH OF MASSACHUSETTS
S� BOARD OF HEALTH,.
.......ram`
...........................OF...
..........................................................
Trrtifiratr of TOmpliatta
THIS IS-T-O CERTIFr, That t,e Indivi ual Sewage Disposal System constructed ( or Repaired ( )
------- - -------------------------
rjrtstaller /
at----------------41- ----------------- .............................. ---/_:� ------------------?1_5�-------------------------------------------------------------
has been installed. in accordance with the provisions of Arti e I f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___. .�_�................... dated-.-.- ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector----------------------------------------------------------------------- ----------
THE COMMONWEALTH OF MASSACHUSETTS x
BOARD OF . HEALTH/
/OF e �
........:� ......
No. - _ FEE. .....................
- ,� �r
Permission is herebyranted....:*
to Construct ( or Repair� ( ) an Individual Sewage Disposal System
-�� se S',.s:M *. ....................
yr` %6.^'gm>cdu�k•a.s**'swo /1rA°i�a
at No. � ---------- -- "�
� Street
as shown on the application for Disposal'Works Construction P ,o it ____________________ Dated...... --••-
�,.1
/ /�� Board of H th
DATE-----t/�„--- ----1--- ------------------------------------------------------
FORM I255 OB65 & WARREN. ING.. PUBLISHERS � '