HomeMy WebLinkAbout0099 MEGAN ROAD - Health (2) a- 9a— �� ��}�gnr� )S
r
No.'----/ //......... Fs�.... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEA TH
.._.......OF........ . ----...... - ---- ---- --------------------•---
A liration -for Did oml ork�orRepair
tstrurtion rroiit
Application is hereby made for a Permit to Construct ( ) ( ) an Individual Sewage Disposal
Syst t:
l 'fie' .........,
.................... -------------------------
Locatio Ad ss or Lot No.
,/ wner Address
... . .!`t6��i �'--_ -----------•-----------•---•-----•---------------------------•---••--••-•--•---••--•---------••-•-
Installer Address
Q Type of Buildi, Size Lot----------------------------Sq. feet
U. Dwelling—No. of Bedrooms...._____--- --------------Expansion Attic ( ) Garbage Grinder ( )
a4 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures _ _
Q
W Design Flow ... ___ _-____ allons per person per day. Total daily flow............................................gallons.
W Septic T . .
ank Liquid capacity__ _ _gallons Length________________ Width------ iameter................ Depth---.------------
x Disposal Trench—No- ----------- ...... Widtl .._._...._.. ._ . �1 Le h ,______ tal leaching area.._.__...__..____...sq. ft.
Seepage Pit No..... ............ Diameter.. ._ ept e m e _.....:.. ,...�Tleaching area_____..___.______.sq. it.
Other Distribution box ( ) Dosing tank � _
Percolation Test Results Performed b ---------------------------------------------------------- Date--__-------_____
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water........................
Tek Pit No. 2................minutes per i ch Depth'of Test Pit.................... Depth to ground water-_._._--_--_--_.--_-----
W lion
-------------
- -Descrip of Soil______________________ _
-- _...- !.....
U ----------- --•------.-------•--------•-----------------------------•------------------•---------.-----------------•-------••---------•--•-------•------ .............................................
W --•------------------------------------------------•-----------•---------------.-•-•----------------------------------------------------------------------------------..----- --
UNature�of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------ --------------------------------------------•---------------------- .--.----.------------------------ ----------------
Agreem�nt:
The.\undersigned agrees to install the aforedescribed Indivi tal Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary ode The a rsigned urther agrees not to place the system in
operation until a Certificate of Compliance has b i by th r of 'ealth.
\ Signe --- . .--- ----- ---- ---------•- - ---•----------�-------------
' Dat
Application Approved BY--- -- - - -----fi LPL-- ---- ------------- r t
Date
Application Disapproved for the following reasons:............................... ......................................... .........................
---------------------••..........-•---------•-----------------•-----•-------- ------••--------•------------------------------------•-------------------
/� Date
Permit No. Issued... // -- ..
...........
ata
..... ...........
ApplicationTHE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HE
w~�
hereby ' ' or RepairSewage
----------------------- It ----jj - -----------------------------------------------------------
wi4w..r Address
�./_ .fdoda....... .............................
kInstaller .........Addres.s..........................................
SysteqVat
Dwelling X/o. of Bedrooms---------*..... .................E,
Septic /
Other Distribution box Dosing ta k
~~ Percolation Iovt De,ubx Performed by-------------------------------------------------------------------------- Date--_._.
Tes Pit No. l----------------minutes per inch I}cpt6 of Test Pit--------------------- Depth to ground water------------------------
Tes pit No 2................m�ut�`/peri ch Depthn of Test Pit. ... ..... Depth.to.g.round water--
--_..
�� Dcscr�ti000f So�'------ --- ------------ -------'_--'
............................ ........ ................................................................................................--'--------'-----------
--'--''----.-'--'_'---_--------' --____----.--'''''-__-'-----''_''--------'---.---_'.-
U Nature of Repairs or Alterations -Answer when applicable�------.---.._-----.---------------.
r�
_-_-----_--_-------------'-'_.___.--.',-------_.__-----------------_
'°,'
The undersigned agrees to install the
the provisions of Article XI of the State Sanitary ode The u A-rsigned jurther agrees not to place the system in
'
� Application Approved B - ' --
Apv"`^""" "=axv^",=^ /~ the /"°"w°g ~°°^"'s-'------'----`---'-'---`'------------'----......
�
--_--.-----.-_''_-.-'''__---- -'--.'----'-_---_-''-'--.'----'--__
o"te
Permit No......................... � ''_
o"m
THE COMMONWEALTH orwAssxcxussTrs
.................. ...................
rtif irate of Q.Tkompfiaurr
THI IS TO ICE IF� T the IndMidpXr Sewage Disposal System constructed (6/' )A�®r Repaired
by.i ... -- ---- -------- -- ........ .... ... . ...... -------------_-------------------------------------------------------------------
Installe
' at..' .6 , A
r ��O�.,rvCodnos »eco mnta | u on arcoruauoeWith theprov,v/oos ot Article Stote e-as escribed in the
applicationConstruction Permit I�o-.---'�������---�-- dxcd'�� ---_
T 14;*E ISSUANCE OF 15r��ERTIFICATE SHALL NOT BE ����M8STRWEDx�S ^� �����^�0���� THAT THE
SYSTE4"WILL FUNCTION SATISFACTORY.
DATE..................................................................�............ ._.--_'_-_ ----------------------------------------- '----
(
'
. �~~ THE COMMONWEALTH or wAss^c*usErrs �
EBOA ' HEALTH
-'c]F-' .,'---
rU
N � '� - �� ~ F
Permission i reby granted......�eo ......... ... ------------.......................................................