HomeMy WebLinkAbout0109 MEGAN ROAD - Health (2) lob ,O'1e
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FRs... �.._
THE COMMONWEALTH OF MASSACHUSETTS F
BOARD OR HEALTH
Appliration for Disposal Workii Tonfitrnrtinn Prrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: /
------"------• /�-----'--------------- ........... ....... �.,..� ------------------ ---
Location-Addres or Lot No.
..................................
- ...............r•............ -----•----------- ....... ------•-----•--•-----•----'•--"----••---
- O Address
Installer Address �A
UType of Building '_ Size Lot....Z. ..Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
a14 Other—Type of Building No. of persons............................ Showers
g --•--_--..��-------------•--- P ( ) — Cafeteria ( )
dOther fixtures ......................................................--------------------•-------•-------•-•••---------------------------•--•-•••---••••••••••_...._
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capaci ,gallons Length................ Width...........----- Diameter-------------.__ Depth----------------
s osal Trench— ___ Width___ Total),,..___._
x p l
Seepage Pit N engti_ _____ ________ Total leaching area._...__________.__._sq. ft.
Di o. ::= �i�meter.................... e ow inlet.................... Total leaching area___3'�sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.............. .........................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
rX4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-____________-_________-
Ix •---- r -
O Description of Soil___- �
V ------------------------------------------------------------------- -----•-----•--•••••••-••••------•-•••••••••••--------•-•----••••---•-----------•----••----•---------------------••......-----------
W --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V 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 Code— The dersigned fu ier agrees not to place the system in.
operation until a Certificate of Compliance has been iss d e board of �y�j,�J
,��7
Signed-----[r..
........................ ---------------- -----------
---------- -------------------- ---------
Date"
Application Approved By...........--------------------•-•--•-••--••••-----------------••......•--•-•=----•----•-=
Date
Application Disapproved for the following reasons:-----------•-----•-•----•--•-------------------------------------
-------•--------•--------------------•------------•-•-•----------•-----•-•------------------------------......................................
.......
• ............................
Date
Permit No................ Issued. '
Date
No... � Fine ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
......
Applieatimat for Biaposal Worku Tomitrurtion Prrmtit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
0. Location?Add�re
C or Lot No.
......................... ......................�•........... .................. ............._..... ------••-------------•---•----.....•-----
W �� O r Address
............. ..........•••----•-•-----....-------•----•....------------......................... ......................-•-------------..................................• ......................
Installer Address �'
UType of Building — Size Lot____ `�.. ...Sq. feet
Dwelling—No. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures
Design Flow................................�..�.....>gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capac - -----------gallons Length................ Width---------------- Diameter..........------ Depth__.-_--_-----_
x Disposal Trench— Width---. ---- otal � Total leaching area--------------------sq. ft.
Seepage Pit No, meter--••-•------------- ept e ow net.
Total leaching area---�-'w�-----sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY.......................................................................... Date...................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
._-
�Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
O Description of Soil....��yrC -
._ -
p ----...---
W
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—The t1ndersigned f7laier agrees not to place the system in
operation until a Certificate of Compliance has bee is ed e board , fJj'
Signed__ o
Date
ApplicationApproved BY.................................................................................................. ........-•-•--.....-•-------------------
Date
Application Disapproved for the following reasons----------------••--------------•-------•-----------------------•---•-----------------•----•---------------------
....-••---------------••--•--•••------------------•••--•-----•••---•-----•••----•--•--------------••--------•--•-----•-----------•----•-•••-•--------------•-------------..---•----••--•-•-----•--•---
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT �, "— 71
...........O F.. ..........................
w-Urrtifiratr of Tomtpiiatirr
THIS IS TO i;aRTIFY, T4& the In ' dual Se ge Disposal System constructed (�r Repaired ( )
b - .�
g Installer
------------ -------•----------------- _.. ------•-•-•------•-•••-
s been installed in accordance with the provisions of Article XI of The State Sanitar
hay Code s desc ibed in the
application for Disposal Works Construction Permit No------------`2.3./_-....._------ dated..._ �� 7-Z........._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................... ---------................................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
. ...................BOARD HEALT �
No.......`� ...../ FEE....2.
Dinvoli irk (9vi mat prutit
Permission is eby granted.--•-=-- --��' ------------- • -----"' "•=- ----/----••------,.....................................
to Construct (r R an Individu � posal Syst
at No. / -----------
f/ * Street
as or
shown on the application for Disposal Works Construction P it No____: _._.. Dated..__` _ _••---_-.
/f "...=� �1{ •---•---- -.-------
DATE. Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS