HomeMy WebLinkAbout0132 MEGAN ROAD - Health 13a �
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No...�.•--(d.- 1 0 — O to F��.... ,..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_/ .OF................. S_T_A�LE.................................
��WAA'
ppliratiun -fur Biupuiitti Murky Tongtrurtiun Vrruift
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System
cC--....
tion-Add r s or.Lot No.
........... ..
Ow Address
a -------•-•• -----------------------•-----------•--....•-----'---'-------...._._..---------------------•-••.
taller Address
Q Type of Buildin�ggs� Size Lot...��_ ._4""_(�._Sq. feet
U Dwelling-No. of Bedrooms------------------ ----_-___••_--_----_.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-------------------------- Showers ( ) — Cafeteria ( )
Other,.fixtures ..__...
1 ---- --- ----------
W Design Flow..#............._____d,.7_._ _.�...._ �allons per person per day. Total daily flow---------- _______.__....._................gallons.
WSeptic Tank Liquid capacity�p-.!!gallons Length-----------_--- Width................ Diameter..........------ Depth...___.____.....
x Disposal Trench—No. .................... Width._. __ ____________ Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No-----.._. ...._.. Diameter/ �.--_ Depth below inlet............ ..... T tal leaching area.---..-.-.----___sq. it.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------•----------------- ---•------------------ Date----•-----------------------------------
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water.-----------------------
rZ4 Test Pit No. 2................minutes r inch De th of Test Pit_...... ••- _--__ Depth to ground water__.....__-_._..___...-..
-••---'•------ -----
.........-•---------'---.-----
ODescription of Soil----------------- . . --•-••-•--••. -------------------------------
x
U ---•-•--••-•••-••------•-'---------------•----•-•-•-....•--•--•-•-•-----------'-------------------••----••-•-...---•••--•-••. --•--••-••--••-•--•••-•---•-•-•-•------------•--------•-•---------------.
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—Th undersigned further agrees not to place the stem -
operation until a Certificate of Compliance has be • su the boar
igned---- --- - --- -- - -- ------ - ------- -----
• Da
Application Approved By....... ...... . -•--•-' .................. •• . =!Y. .....-- w'"� -ace--73
Application Disapproved for the following reasons:-----•---------•------------------------•-- .............................
. ------. ------------------
------- ... ..........
_ ate
Permit No. Issue �//
5 ��
-------- --- -----------------------------
Date
No.. or... Flciic.. ................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
....... ....OF...................B NSTABLE
...................................
Apphration -for Disposal Vorkii ( omi.trurtiott Vrrtttit
Application is hereby made for a Permit to-Constructor Repair ( ) an Individual Sewage Disposal
Syst
.. . . ........a.. .... .... .....i... ..........................................................................
ation•Add ss or Lot No.
�............. --------- =- -•--------------------------------••-------•----------_.-...--_-------------------•---.-----------
Ow Address
a ... .................................................
•-_------•.............................. ............................ - ----------•-
staller Address
d Type of Buildin, Size Lot_
All," feet
U
,-I Dwelling—No. of Bedrooms_-<--------------------------------.':------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ___ ________________________ No. of persons-----------::---------------- Showers ( ) — Cafeteria ( )
Other fixture ..
-ey- ,.,,ti. �
-----------------------------------------------------------------------•-_..._
AVI
W Design Flow.x........... :. __. -- gallons per person per day. Total daily flow-__--__ gallons.
WSePtic Tattkl-Liquid capacitgallons Length---------------- Width . -- Diameter_. __ Depth................
x Disposal-Trench—No ____________________ Wi -11', _. ..._____..__ Total Length-------............. Total leaching area--------------.-----sq. ft.
Seepage Pit•No........./________ Diamete> ._:I Depth below inlet........... T taI leaching area
------- --------- ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed b _________________ Date----------------------------------------
Test Pit Na. •1---------------__minutes'per inch Depth of Test. Pit.................... Depth to ground water..-._-.____-_-.---.__.
f� Test Pit`NO. 2________________minutes er inch D th"bf Test Pit ___ ------ Depth to round water-,_._----___--_-._-_-___.
-• ---
O Description of Soil------ ------ _ ----
x
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=T undersigned further agrees not to place the 5
operation until a Certificate of Compliance has be u the boar
igned-- -------------
Application Approved B D
.. � Date
Application',Disapproved f or,,the following reasons:---------- :..es ------ ---- ----- _____-_- _-----_ _------______---.------
-------------- ----------.---- ,------ •------------- ---- --- --------------------------- ---- ------- --
,• ate
Permit No.............. ..D ..
--------------------------• __._.... Issued.---��. _r'.� •�5
w` Date
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
� r c.�..... BARNSTA,BLE
OF.....................................................................................
0rrtifirate of Wlimpliaurr,
T S TO C IFY, t,,the In I idual Se age Disposal System constructed ( or Repaired ( )
by ••-•-•. - -----
Installe
at....--- -- -- ------- -- ........... . .... ---*"I.........................................
has been installed in accordance with the 'ovisions of Arti e I o The Sta e Sanitary c, as escribed in the
application for Disposal Works Construction Permit Not.__ ' datedl .
----------•---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT'BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM /A/ LL ONCT N SATISFACTORY.
DATE" 2 f'
�r1: I . Ipe
1 THE COMMONWEALTH OF'MASSACHUSETTS
1 BOAR;D OF HEALTH
..................... .C O F : B.ARNSTASLE..............................
:. .
NO._ .................. j FEE. r_.__. ....
. . o � . lurk Cnott trioarritit
Permission is hereby granxed_4w..• ----------` - _ .-..._...
to Constru or Re air ( ) ndividual Sewage o 1 Syste
at No..: i5�--F--- •. ....... ..... . F- -"----- �'f" '~ +
Street
as shown on the application for Disposal Works Construction P t No._ ted__Q" •-
r .�' --
0 _._ ......... y '�
{" �� �/ Board of Health �- - r!
DATE----------------..........-/----------.,-r�.............................. 1
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
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