HomeMy WebLinkAbout0050 MEGAN ROAD - Health (2) tAf G PAN RD� � -�,
No.-•Y ....... ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ---
......--------OF..........
.......................-
Lo Apphration -for Diipuial Workii rrm t
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst at
111 ........................................ -------------
92 7
Loc -A- dress or Lot No.
........... --- . .................. •---------•--•---------•-------•-------.........••----•--•--•--•--------........._................
5........
caner Address
W .....
Installer Address
U Type of Buildit Size Lot.--- *2.._ -_=Sq. feet
Dwelling—No. of Bedrooms--------------- ...................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons.--___--__--..--_---.-_--.__ Showers ( ) — Cafeteria ( )
Q' Other fixtures ________ _______
d
Flow . ------ �-- P P P Y Y --------------------
Design Wallons er person per day. Total daily flow__________._______________________gallons.
Ri Septic Tanl�Liquid capacity/�--'gallons Length---------------- Width................ Diameter---------------- Depth_.-_____.-.--.
W Disposal Trench—No. .................... Wi li.._________ otal L h_.__... .......... otal leaching area--------------------sq. ft.
x
Seepage Pit No....../----------- Diameter. . ___. ep w inlet________ :_... T 1 leacltittg ttre:t..................sq. tt.
Z Other Distribution box ( ) Dosing tank ( )
�-' Percolation Test Results Performed bY.......................................................................... Date----------•-------------------------....
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.---.---.-------.------
Li Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-.-.--_-----.--.-....
---------- ------ ----------- ---------- ----- ---•------------- -•-•- ----------•-------------------------------------
0 Description of Soil--- ----------------------------------- - -------- ------
x
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 dersigned further agrees not to place the system in
operation until a Certificate of Compliance has e i ed by board Of healtl-L
4 jr. I? /�' ��
tgne ►'� ---------------• •- - -•--•- -----•-
Date
ApplicationApproved By.... --------------------------- —---- -- -•--- ------- ...................... -----------------
Date
Application Disapproved for the following reasons----------------•------------------ ............4--------------•----•--•...........-••---••----•-----•-----•---
----------------•--•--...--•---------.........----------------•-----••------••-------•-----------------•-•---------------------•---•------------------ •---•-.----- ----------------------------------
Date
PermitNo.---------••-•-•-•------------------------•------------.. Issued.....7 �� ----7•---••---•--------
D e
NO.. 'f 4 7-----•• Fu$.....: ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD -
.. .
-- -- OF....... . .... ....::..:.... - ................... .........
Applirtt#iun -fur 43iupuuttl urku unu#rnr#nun Vrru i# 4
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst at K 3 1
Loc i A dress or Lot No.
Wner Address
� Installer . .tee Address �•�`�
d Type of Buildi�g Size Lot______--_; -------------Sq. feet
aDwelling '—'"No. of Bedrooms_____________________..________Expansion Attic ( ) Garbage Grinder ( )
pa Other=Type .of Building ____________________________ No. of persons......... _:_______________ Showers ( ) — Cafeteria ( )
Q' Other fixtures -------I. _ __
W Design Flow_ ____________________ 1llons per person per day. Total daily flow________..----_..._,._...`.....__gallons.
WSeptic "l anl —Liquid capacity_ allons Length---------------- Width_.__..__....-.. Diameter--------------- Depth................
x Disposal Trench- o_ ________________ ___ Width___________ __,_�y,ottal h_______ ____.___. otal leaching area.___________.______sq. ft.
Seepage Pit N ) DiameterI�.____. ep"trl'boffo—win et________ l 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 "Pest Pit-------------------- Depth to ground water...____--______._._-.---
Ii Test Pit No. 2................minutes per inch. Depth of Test Pit-----:._. :________ Depth to ground water__.._-_..______--_-_-.
0 ' Description of Soil---------------------------
-----------------------------------------------------------------•-------------------------------------------------------------------
VW Nature of Repairs or Alterations—Answer when applicable.._-__'�-=--------------•"-•----•---•--••-------'•-------••-----------•-•----.-------•-------- [
P' -------------•---•---_.__,----•-•--:........................---•------- --------•-_-....
-----------------------
----------
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 dersigned"further agrees not to place the system in
operation until a Certificate of Compliance has e i ed by board'f health.
4
Y XV �
III VVV II//'' � i..
lgrie _
Date
Application Approved By...... ._ -- ...................... ----------------
K Date
Application Disapproved for the f o/dowig reasons:....._:...........................
--•-----------------------
Date
Permit--No-------------------------------------------------------------------- Issued--------•-•------•----------------------------------•---
` Date
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
................O F....... l.t..Z-.............,........,.....--...---..........
"WIrr#ifirate of womplianrr
/eeninstalled
S TO RTIFY hat th ndividual Sewage Disposal System Constructed ) or Repaire ( )
/ Installer
- ---------------
-------------
lias in accordan e with the provisions of Artic e of The State;-.Samtary Code as describ n the
application for Disposal Works CorrStructidn Permit No____________ __ 0-.--- ��- _.. __... ,�________._.
dated �.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT ON SA ISFACTORY.
DATE.-•--••----••--7_ •--_ -•-_. Inspector------
---•-----------•--•-------•----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFF HEALTH
............ .. ... Z.....OF.......... ..... ........................................................
NO...."1.. __'e...... FEE.__y�'
. �i��u� 1 irk � ��uu#r #iva rr�ti#. .� •
•
Permission is ereby 4an.. d-r--•- - :--•--___--•-•-•-------
to Construc ((/ or R ) an IndividX;i
ge is o 1 Systemat No._ LF�----- �--- . . 00,
•- --•---- -----------
f `
Street
as shown on the application for Disposal Works Construction r Dated_ ___(_( "_-_.. _______
_...---- ------------•--
DATE----=--- =................................. --
Board of ealth I•,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS , a