HomeMy WebLinkAbout0074 MEGAN ROAD - Health �w MEGaro RD �
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THE COMMONWEALTH OF MASSACHUSETTS
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Application is herky made for a Permit to Construct (~�7 I�epmi ) an Individual
System at
' -- =�...c - ~ ^ .........................' - -----------_--.............................. �_-'�---�-�---��-'
Lot
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���
--__-'_________---__._-'_____ __-_--_--_-_-__--_----_---'--_'--___-
Installer Addres s
'�� �
Iyyr of Building Size Lot.�.�.x�..��-u-u--S�� feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ----.--_-.- No. of persons--_--.----- Showers ( ) -- Cafeteria ( )
�
Otl2gr fixtures
Design Flow A-e->
Disposal Trench—N2��---
Other Distribution box ( ) Dosing tank ( )
~~ Percolation Icvt Results I'oforoze6 by--------- Date............. .-.-------
Ievt Pit No. l----------------miuutospozincb Depth of Test Pit-------------------- Depth to ground water------- -----
Ies Pit No. 2................minutes per inch Depth of Test Pit.................... Depth u/ ground water.-------'
D
Description of S ----_-----------_--------
----------------'--`----------`------------------`---`---'---------'--------
.-__-------.---.--'._._-'_-------'____-.-_------_--_.---_--__-'------.-----
U Nature of Repairs or Alterations—Answerwhen ayplicu6le.---.--------------.-----------.--'
.-_-.-------'-_---------.--._---_--__-_.--_----.---.-----.------------_--
Agreeoeot:
/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
02
No---------- ............ ..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOA R2"H E
OF.. .......
Appitration -for 4iipoiia1 Worko Tomitrurtion Vrruiff
Application is, her y made for a Permit to Construct (.0�or Re pair an Individual Sewage Disposal
System at: /,00
of.
......... ........................ ................................ -------------- .......................................................... ..................................
0 tion-Address or Lot No..................... - ----------- . .......It ...... .. .................................................................................................
wner Address
................. .... . ...... ...... ............................ ............ ..................................................................................................
Installer --�,Address
Type of Building Lot-./ -?5f/
U Size',L _Sq. feet
----4�_Dwelling—No. of Bedrooms._- --------------------------Expansion Attic Garbage Grinder ( )
P4 Other—Type of Building ---------------------- No. of persons---------------------------- Showers Cafeteria ( )
P4Otlyr fixtures ----- --------- ..................!�---------_----------- ------------------------------------------------------------------------------------------
Design Flow .......... gallons per person per day. Total daily flow___________________-------------------------gallons.'
----------
P.
1:4 Septic Ta ti —Liquid gallons Length. Width................ Diameter---------- ..... Depth......I---------le ca a04�0_v
-Disposal Trench—N� --- Width._.__..___._.... :. Total. .-Total leachi'di",area-.-.--. ---.........sq. f t.
Seepage Pit No...................... Diameter.___-___-___-_._:-__ Depth below inlet__.................. Total leaching area------- ----------scl. f t.
Other Distribution box- Dosing"t'ank.
Percolation Test Results Performed by------------------------ Date-------------------I-------------- ------
................................................
Test Pit No. I-----------------minutes.per inch Depth:of Te§i ----------------- Depth to ground water........ -----------I....
CL, Test Pit No. 2................minutes per inch Depth of Test Pit.-:--------- Depth to,ground water__.-_.--- _-_.-_-._
9 OiI�... ....... - -------------------------- .....................................................................
0 ,ate1��----------
XDescription of S --------i7---------is------------ ------------------------------------------------------- .................
U ------------------------------------------------------------------------------:....................................:-------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 Coe— The undersigned fI agrees not to place the system in
operation until a Certificate of Compliance has
be sSled b)A oard o !alth.
�T ' ->
igned.
Xta -- ----------- ------ ------------
-------_----- .....jv/-
---------------
Date
Application Approved By------------- ---------------- ----------------------------------------
Application Disapproved for the following reasons:...... Date
............. -----------Q,------- •---------------------------------------------------------------------
...................................................................................................................................................... -------------------------------------------------
Date
Permit No.................I......I
.................................. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARDQF HEALTKY.,. .......................OF..... ..............................................................................
Tatifirate of Tontlitiattrr
THIS IS X -�FIFY Disposal System constructed " Repaired
b .................. ............... ------------------------------..........................
y ---------------- ------------------------------------------------------------------------------- .......
Installe
-----------
- -------- ...............at.... ..... .... ....................................................... ................................... ......................................
has been installed in accordance with the provisions of Article XI of The State unitary C S esc 'be(Li the
,ni . v .,od a d
�1'ZI
application for Disposal Works Construction Permit No------------------ -------- ----------- dated.-4- .- -5-- .
----- ---- ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G�AIRANT E THAT THE
SYSTEM W LL FUNCTION_ TIS ACTORY. '�2
00
........ ............................ ........
m-----.................................. Inspector... ..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARDOE HEALT
1
. .... . ...............007..... ......... ..........................40......................
No......................... FEE........................
Permission is h ----------------------------------
_��by granted ---------------------------------------------------------------------V�........................................
to Constru t or epair an Individtj.4 SewagSOisposal Sy to
at .. ........ . . .......... .... ....................................... ...
Street
application - - --------------I as shown on the )plication for Disposal Works Construction Dated - ------------
...i on
....... ---- - .4p!-V-------------------------------------
Board of Hef,�
DATE.. -----------------------------------------.-
...............
FORM' 1255 HOBBS & WARREN. INC. PUBLISHERS