HomeMy WebLinkAbout0058 MEGAN ROAD - Health (2) 8 MEGAft RDHDL4:?-- �v
F
THE COMMONWEALTH OF MASSACHUSETTS
Application is hereby made for a Permit to Construct (/V/) or Re air an Individual Sewage Disposal
Syst at:
at
ys
or Lot No.
0 Address
Installer Address
jye f Bill 2' ,:F—o 0 7/1 q. feet
Disposal Trench Width....... ota?l pth.... ..... ..... Total leaching area--------------------sq. f t.
Z Other Distribution box Dosing tank ( ) 0'0 --,
----------------------'-----'--------'--------------'--------------'
Agcrrmrot:
The undersigned agrees to install deafore6esoibe6 Individual Sewage Disposal System inaccordance with
operation until a Certificate of Compliance has lb��Miy I 4ohealth. V
Date
the provisions of Article XI of the State Sanitary de he undersi e further agrees not to place the system in
Date
PermitNo......................................................... Issued....;/7 - ...............
'-------------'---------------
O
No.....J--_� ---•-•• Fux ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
.OF....
...:...: .. ----------_---..------
Aplriiration -for Bhip fiat orkii Tonitrnrtion permit
Application is hereby made for a Permit to Construct (/0``) or:Re air ( ) an Individual Sewage• Disposal
Syst at:
7 ...Z 0/
........................
Location_ d ss or Lot No.
--•-- - ...... .-A.—........... ... .............. •-----•--•-•------------•___.____.---...__..•----------•------._.----_____._•__-._..__-•--_.____
p Address
a
� Instal er Address .r'
Type of Build Size Lot-._ _>�:____-____Sq. feet
Dwelling—No. of Bedrooms------ ..........................Expansion 'Attic ( ) Garbage Grinder ( )
Other—Type of Building ____ ______________________ No. of persons............................. Showers ( ) — Cafeteria ( )
0.' Other fixtures
- • _.-.__... -- - --
W Design Flow_l ____________________ _ .. dons per person per day. Total daily flow-----"' .__._._._...___....gallons.
WSeptic Taal{Liquid capacity -_ --._ allons Length---------------- Width..:............. Diameter---------- Depth..-..-.---------
x Disposal Trench— _ o_____________________ Width_.___.._ _. __ ._ _ Total h--- _--__ _---- Total leaching area-_-_-_--.__-_-_sq. ft.
Seepage Pit No._�L�_..__._._.. Diameter/__ __. __ ep w m e ____:_______________ To leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) 49 Q --�,...,,•,,T
~' Percolation Test Results Performed by-----------'-------------------------------------------------------------- Date------------------------------......
_..
l Test Pit No. I................minutes per inch Depth of Test Pit...,..................... Depth to ground water..-.---..----:_.-.--.--.
w; Test Pit No. 2________________minutes per inch Depth of Test Pit..__________________ Depth to ground water_.__._________..___.._.
O Description of Soil----- '± C' '
x
-------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable:---------------------------------------------------------------------------------------------
.r., - ..
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary qode Whe undersi further agrees not to place the system in
operation until a Certificate of Compliance has b i by the bo health.
ned - ------ ----- ----- -------- --•--•••--
D
Application Approved B .t......... .... ............. _- e..�
. Date
Application Disapproved for the following reasons_____________________________________ ................•-•--•.___...-•--•-•-••--......... -------
__._--.
.......................•--------------- .........:-••---••_••-••..............................---------------------------------------------------- .............
} Date
Permit No. Issued. == :•••••••••-
r,' Date
f
THE COMMONWEALTH ,OF MASSACHUSETTS
. BOARD O HEALTH
....7V-z :.............OF......... .... " ............e............... ..
rtifira#e of �umPlianrr ��� �
T IS aTO �,ERT_ZW,� That e Individua sewage Disposal System constructed ('' ) or Repairedby-_... _ --_•-• ='.. - • ••••---- ------=------- --------------•-•••••--•••-•-----•------•------------------•--•••--_•-•••••--•---------
i Installer
a /�. .. - .. - - --------------------------------------------------••----------•------------
has been installed in accordance with the provisions of Articl XI of The State Sanitary Code s descl; ed in the
application for Disposal Works,Construction Permit No--------------- f�___._...._. dated...... / ___��
THE ISSUANCE OF THIS CERTIFICAIT-f-,SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEW W' ILL FUNCTION SATISFACTORY.
DATE................° Inspector. == =-••------•---•---•:•-•-_•_.__•__•................•-_.
- •. THE COMMONWEALTH OF MASSACHUSETTS
,.
BOAR O F HEALTH `'2
s..
No.--- -/---•---•-- FEE
- > g el.ndividual
lark anti nr i tt Wrmft
Permission is hereby grantedt�►y ----•-__-•-
to Construct_( r Repair ( an` S ag , isposal' y em
71
atNo.----- e ------•------•-----------• -- • ••--_---
LL
-.i as shown on the application for Dispo al Works Constructio o Dated------�. 17, ...
"T ..
f
+ e oar of
He
DATE------- ---• --- ------------- •-----.... • •
FORM 1255 HOBBS & WAR EN. INC,. PUBLISH ERS -