HomeMy WebLinkAbout0043 MEGAN ROAD - Health (2) I m-etaa Q v1
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THE�COMMONWEALTH OF� TS
EAL u �...�
Appliration -fur ]iiipuiitti Workii Tontitrurtion 13Prmit
Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal
System at: f
-------------------------------------- -% ' '. .................................
Loc o - ddress or Lot No.
•....................-------........ -- . .. .................... ............ ..---------••------------•----•---•---------------------------•----------------------.....--------
wner Address
...............................•---•--------
Installer Address
U Type of Building Size Lot..... s� Sq. feet
0-2
Dwelling—No. of Bedrooms--.-_--._ ........................Expansion Attic ( ) Garbage Grinder ( )
ri, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other xture
W Design Flow..... ----gallons per person per day. Total daily flow............................................gallons.
Septic Tunk e Liquid ca)acity__. ....... Length................ Width........-------- Diameter-----.---------- Depth----------------
W Disposal Trench—No Width-------------------- Total Length-------------------- Total leaching area---- .X-sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet-------------------- Total leaching area................_.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------•------ --•-------•---•------------•------------------------ Date----------------------------------------
a Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..-.---..-._-..-.-.-----
fi Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---......--._-.---_-.---
04 -----------------------------------------•--•-----------------•-------•------------------------------•-----•-••----------•----------------------•-----------
0 Description of Soil.........
U ............................ --- = ' ----------......---------- ......... .......-------------- --- ------ ------ ------------------- ------- ---- -
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 XI of the State Sanitary Code— Th ndersigne rther agree not tp, plac, the system in
operation until a Certificate of Compliance has bee ued he board ealth. '��'_L/
igned. `
--------------------------------
Date /
Application Approved By----------- _ ---•• �111�L -7/�1.3..,1
Application Disapproved for the following reasons_________________________________
-7--------------------------------------------------
Dat ..............
...............•-•--•--...----•-•-•-•---------------------------•---.._...----•---•-•----------------•--
Date
Permit No......................................................... Issued.---------.....
...----- ----/--;7
-----
Date
•••
No.... ...... ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F H EA L H
.... -- .OF..... ......-----------
I-ra_z� .
Appliratiun -fur Miipuutt1 lVorko Tonotrurtiun PPrntit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:L�l �02 �/ �i� �d�1� �l
lt� ------------------- -------•••••••-•--
Loc o - ddress or Lot No.
t " ---------•------•----
�r Owner Address
a ..........
----•---'
Installer Address
d Type of Building Size Lot.._./�.�G�_Sq. feet
U Dwelling—No. of Bedrooms---------�-_________-••-____-____Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixture
W Design Flow____._ - =_ .-gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic "i'Ittk—Liquid ca pacity___ _______gallons Length---------------- Widtll................ Diameter........... D �tll-_-________-_-..
x Disposal Trench—No�--• Width-------------------- Total Length-------------------- Total leaching area_-��_;Z-_sq. ft.
Seepage Pit No"_-----�--•- Diameter____________________ Depth below inlet._.___.______._____. Total leaching area-__.-_-____-____-_sc. ft.
� P g 1
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_--_______________-___
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-___-__-_______-__----
-----------------------------•--.•.-------------•--------------------._______._.__•••-•••••--•--_••-.........................................................
0 Description of Soil-------- __ ___
x ------------------------ --------- � -�---------- > --------------------__________-------________ .____----------- ---------------
U
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 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.
/�lgried. .............. ....• •-•---•-•--•--••--••---••--•----•------------------------• -Date--------------
Application Approved B �_ � � s � Dat€
Application Disapproved for the following reasons________________________________--------_----------------------------------•-_-_---_-_--__.._..__________
...........................................-----••----------------------•------•---•----------------•---•--------------------------•- --•-----•-----------•---------------------------••---- -•-•••--••
Date
PermitNo......................................................... Issued..------""- ............................................
Date
THE COMMONWEALTH OF MASSACHUSETTS ;? 4?-BOARD FHEAL
.............OF . .-. ..............:................--..-.............-..-..-........--.
Tprtifiratr aif Tantlifiatta
THIS IS TO TI Y, t the In • "dual Sew e Dis osaI System constructed ( or Repaired ( )
by ----- --------------------- ........... -- ---................................•
//�* J / /yam / __________
•-----•-•----•L.l..-...--... �-•-•-"---�5'�Q Inst---e}- iy-•----------------••- �rat__. �/ /�/ '----------------------------------------------
has '
been installed in accordance with the provisions of Article XI of The State Sanitary Code/as descr"bed in the
application for Disposal Works Construction Permit No---------- ---------____ dated--_-7 _.3 ,2 ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL J
'..........of. ..................................... .... . Q..0 .
No._•-• .................. FEE---
.
urk� �. rurt"Ott Wrntit
Permission is h y granted------'\ 1) ,w .2'"' ---- --- . - ,/ �.._._.. t.
to Construcp ( ,�or Repair ) an Individual Sewage Di sal Syst
atNo. 4� ..'1--- ��--��".------ L- ---------------------- ----------------_____-------------------------
s et
as shown on the application for Disposal orks Construction r t No------ _z_____�__ D. ed__,�/.-1 .
------ � ' � !�1[��-� - ----------------
`Board of Health
DATE----------------------------------------------------...........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS