HomeMy WebLinkAbout0100 MEGAN ROAD - Health (2) 7 �Q MCGAN RDA�$�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE
OF............................ .................
�® Appliratiou -fur Uiipuiitt1 Worhs Towitrurtiou Vrruiit
A plication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
s - -
Locatio Add ss or Lot No.
pp O ner " / Address
I alley Address s
Type of Building/ Size Lot/. ..Sq. feet .
U Dwelling No. of Bedrooms..________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons____________________________ Showers ( ) — Cafeteria ( )
a' Other fixtures ----- ------------------------- - -
-----------------------------------------------------------
Desi n Flow_______________________ _ Mons per person per day. Total daily flow............................................gallons.
� W g ��--•-----g� P P P Y• Y -..._. g�
WSeptic Tank—Liquid capacity------------gallons Length.....-.......... Width---------------- Diameter................ Depth----------------
x Disposal Trench—No- ____________________ Width.................... Total Length.................... Total leaching area.......-------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.............. _____ otal I ing area------------------sq. it.
z Other Distribution box ( ) Dosing tank ( ) ��
lam" :?---
Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
Test Pit No. 1----------------minutes per inch Depth of "lest Pit__-____.________-_ Depth to ground water--.-_--_--_----.--.--.-.
( Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
Ix -•---- ---
O
Descrtptton of Soil. ••' --• �-- Cat•
x
f�1 ------------------------------------------------- ---------------------------------------------------------d,--------------------------------_-_..__---•---•------------------------------•--••----
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 ndersi ed further agrees not to place the system in
J
operation until a Certificate of Compliance has be issued e bo d of health. -�1�
tgned--• ----- - ----------�--- --
Date
Application Approved By-----•-- - /�i - -__--- �__�-_-- -- -. _ _ _--•- _-..
Da
Application Disapproved for the following reasons:--••-•-•-- --•---•-----•--------•-------•--•---•-------•------------------------------------•-•-----------------
••---•-•-•---•-••-•••---••••-••-•-••------------------•----•-----------------------•---•-•-••-•--••---•--•••-•----------•----------•-----•-----•-•-•-- .............................................
Date
PermitNo......................................................... Issued---------------------- .................................
Date
. 1
............
THE COM/AM�ONNWEALTH OF MASSACHUSETTS
RD9 I HE.A,-'--rFk
Applirtttion -for Riipoiitti Worka (�on� rnrtton rrflnt�
A plication is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
s
--•--- ---•-- ...... ..-- _.. -------•••- _--------- --- •... --•---•-•-• ----• --•-. •••-- -----------------------------•---
-•
Locatio -Add ss or Lot No.
O ne Address
I alter Address /
U Type of Building/ " Size Lo �,� . . _�" Sq. feet
Dwelling No. of Bedrooms--------- _______________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No..of persons.--------------------------- Showers ( ) — Cafeteria ( )
aI Other fixtures
� ^� •-•-•------------------•-----------------------------------------------------------------------
W Design Flow-----------_---------�7 U--•-•----.gallons per person per day. Total daily flow_._.___.____...__......____.................gallons.
WSeptic Tattk—Liquid capacity-_.-_-_-:_:gallons Length-------------_ Width------ Diameter................ Depth-----._.___-_---
xDisposal Trench'—No...._:_,,_,._.___-___ Width_.___--__-'__-----_-- Total Length______________;---------------- Total leaching area--------------------sq. ft.
I Seepage Pit No..................... Diameter.......... ------ Depth below inlet__________________,,}Total l ing area-- ------____sq. ft.
z Other Distribution box ( ) Dosing tank (. )
Percolation Test Results Performed by __
a ------•--:•-•----•- ---------•---------••------__ Date------------------------------------- -
Test Pit No. 1______________minutes p.er'inch Depth.of Test-Pit ______,______- Depth-to ground w.atPr...._. _ _--_.-.._.-....
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to groundwater ..::__-_-__-,-_. .
�+ ------ :.
Description of Soil-•--• -----
---- --
x
W ------------------------- ------------------------------------------- -------=------------------------
-----------------------------=---.---- --------...... :_-------------------------
VNature of Repairs or Alterations—Answer when applicable.#------------------------------ ------:._-:_....:._... ._....__._..._...._.___._.-----.....
----------------------------•-•-----•--•-•--........ --•-•-----------------------•---•-----------•---=------•-•-----------------•--•--•-----___.---•--•---__-_----•------------------------------------
Agreement: h .
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 ndersi d further agrees not to place the system in
operation until a Certificate of Compliance has be issued., e:bo d f health. ��
igned-- -- . ----- •--------------
:. •_ /z< ate01
Of
Application Approved By......
r Da
Application Disapproved for the following,reasons:,-::---.•_______________________ ..............................................................................
--------------------------------------------------------------------- ---=--•------•------------------------•-•------•------_:___--•-•--------------------------------------------------••--•-------
Date
'I
PermitNo--------------------- --•---==-------------------_...-. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
r ..
f
rdifirate of 0.10mlittaurr .
TH S TO CE IF the Ind tdual Sewa e Disposal System constructed ( ) or Repaired ( )
.............=---------•------------------------------
t er
at0!'_ ----- -- --- ................................................
has been ulsfalled in accordance wi the provisions of Article X of The State Sanitary"Coc a escri d t he
application for Disposal.Works Construction Permit No---------------�°4 ------- dated" _. _� 1 !�n�___.
THE ISSUANCE OF YHI�CERTIFICATE SHALL NOT BE CONSTRUED AS A'GUARANTEE THAT THE
SYSTEM WILL FUNCTION SAISFACTORY.
60
- •
DATE-----•-•----. ••---••-••--•----------------- Inspector - ------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD - F HEALT
No, =�0 .v FEE ,,. ''
R-r o or ,q � #ru film lirrmit
Permission is ereby granted ."'{ r#. �''�'-----------------=-----------------•-•-•------... ----
to Constru ( ')'or Repair ( Individual Sewag isp al Syst
atNo._ _.._ ..!`-__------- {� -------- -----. .. - ------ •-•-----
Street
as shown on the application for Disposal Works Construction i. o ___--_-__--_ Dated__...6 . ._✓' !- ___
- ... ... .. ... .. - ---------I------A...................
h
136ard of Health
DATE
l ,
:E W.
FORM 125`5 HOBBS & WARREN. INC.. PU13L1,SHERS'