HomeMy WebLinkAbout0140 MEGAN ROAD - Health (2) 14D &?�o RbG-d
i
No..•�(-3 t 1 Fss.. .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
JS�'[1 / .......OF.....:.............gS .4sLE...............................
ppliratiun -for 13islia' sal Works Towi#rurtton Vrruiit
Application is hereby made for a Permit to Construct ( or Repair ) an..Individual Sewage Disposal
System a .
ocation-Address or Lot No.
Owner Address
W
,a •-•-••-- ... . -- -------•-
I aller Address
Type of Build Size Lot... ./....7V_/..Sq. feet
U Dwelling—No. of Bedrooms...__-- -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -------------_-----.______ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ................ .... .
d
W Design Flow... ._ a o r per on r da . otal,d1ily flow...._ ...gallons.
v[[
WSeptic Tank Liquid capacity -A all e t -----!� i..____._.-___.. Diameter- -------------- Depth._.----.---.----
x Disposal Trench—No ____________________ Width. _.____._ _____ _ L gth. al leac ipg area_.__________.___...sq. ft.
Seepage Pit No ........ Diameter ep bel w ice-`-------------------- thing area__..._.___.__..__sq. it.
Z Otlier Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------_ ------ ................................................... Date---------•------------------------------
`�a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi Test Pit No. 2................minutes per inch epth of Test Pit-------------- Depth to ground ater.-._--._______-..___.---
----Description of Soil -••-•-. --•--------- --
x
c, ------
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 YI of the State Sanitary Code— undersigne rther agrees not to �la� the sy em in
operation until a Certificate of Compliance has b y he b r ealth. f �
tgne -- -•-------
Date
Application Approved By---- ------ ---• --- ��
to
Application Disapproved for the following reasons--------------------------•------• -- ---------------------------------------------••-----------------------•-
........................•---•-------.....--•••---••-••--••--•-•-•••-•------------•-•-•••----•----•-----•-•----••---------••-------•-----------•-•--•---•-------•-----------•---------------------------
"':.., , Date
Permit No. ......r Issued l
k Date
---------------------------------------------------------------
1ti�
...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
p B1YLE.
Appliratiun "fur Riiplaiittl Works Tonstrurtiun Prrniit
Application is hereby made for a Permit to Construct ( or Repair ) an Individual Sewage Disposal
System
ocation-Addr ss or Lot No.
-- ----------= _ '_ _ _ 1......
.r Owne Address
W
talle Address r -ry►
U Type of Build Size Lot-./I ! �.Sq. feet
Dwelling—No. of,.-Bedrooms-------- _-_______-_-.-__-Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
dOther- fixtures .
Desi n Flow.. - 1110 r er on r da otal ail flow... ___._._.._.. allons.
WSeptic Tank Liqui capacity all s e t ..._. li__---...._. . Diameter _----- Depth------------
x Disposal Trench—No. Widtho__ ._ _. ngthwy' lea #ng argi ---------------sq. ft.
Seepage Pit No.____. .._._ ._.. Diameter _. e bel.w tr 1!_.. .. 1 ching area-----------------sq. it.
Z Other Distribution box ( ) ,r Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1-----------------minutes per inch Depth of Test Pit.................... Depth to ground water.-.__..-_____-_-.--_-
LL Test Pit No. 2----------------minutes per inch epth of Te t Pit_____________ Depth to ground ater__._.-_-----_.--_.___.
.... .•-
O
Description of Soil----- --• -- r- - ----- -----
U
------------------------------------------------=----- --=-- ------------------=--- -----------------------------------•-------------------------------------------------------------------------
VNature of Pepairs or Alterations .Answer when-applicable..-____________________________________________________________________________________________.
Agreement:
:
The undersigned• agfe'es to install' the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— undersigns rther agrees no to dace the sy em in
operation until a Certificate of Compliance has y he ealth.
igne ..... . ........ ......... ... .. ----- ......... -------------------
Date
Application Approved B . • r�r � r + /
ate
Application Disapproved for the following reasons:_----------------------------• ....:----••-•---•---•---•--•-•---------------------------------
..
Date
e
t'l-.. c^ 'C �&�k�r�y* ��Y+.+Y��'.'� '4�c, l}4^*u F. *�Yy ^YN � F '3•'`AY 4
Permit No; ,� � � �. .� � � •� .�.-..issf�ed: ��.rt z`
at
�t'�' rnd � , ,i:.?W �s 56 •y�'zAR� "4i. ,-4
'''` � � D
THE COMMONWEALTH OF MASSACHUSETTS
/BOARD OF HEALTH
.................. ..r..3c,/.....OF..
.............a6'AZt V.STABE........------------............
(ITrrtifirate of 'anipliaurr '
T .'IS TO C TIFX; at A I,,/�ividual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
....... ---------� _Z -------------
has breninstalled in accordance with th provisions of Article XI o Th tate Sanitary C de desc toed in the
r application for Disposal Works Construction Permit No----- dated
^�►
�� ;:r--
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE AS A GO
THAT THE
SYSTEM ILL FU CT N SATISFACTORY.
—DATE. -----3----------------••••----••-•_-•-_.. Inspector_"z-___- --- •----
THE COMMONWEALTH OF MASSACHUSETTS
-� ---~--
BOARD OF HEALTH 2-
-- .. of " ....:......RAR�tSTABLE -- --------....
No.... FEE... .............
�. �i�iautt rk IT?
n i�at ``iatit x
't
Permission s reby granted---�---: ------- ..............................
"to„Consfruc or Re air ( ) ndivtdual Sewage Di o. 1 stem
atNo..,., - -- ------•3-1�---------- -------- k -------- -- --•---• • •• --- ---•--•-----••.
' treet
as show on the application for Disposal Works Constructio mtt NoDated___ . :. .._.__.
--f � - ----- ---- - F ----------- Board of Health .
DATE_ - -------,'
FORM 1255' HOBBS &,WARREN. INC.. PUBLISHERS -