HomeMy WebLinkAbout0156 MEGAN ROAD - Health (3) key
No.F :r - v a Fmic )'0
......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE
!� ......�.E. ............................
( -------.._.OF.....
Appliration for 43i6pasal Worko Tongtrurtion Prrutit
Application is hereby made for a Permit to Construct (, or'Repair an Individual Sewage Disposal
System at:
`o;c a" j
------------- ......
.......... . ............................................................................................
, E :Location '�../ or .
.. ...........
................ ................ s ..
........................... . ... .......... ............................................. Lot No.
....................................................
Owner Address
................. . ... ........15------------------- - --------- ..................................................................................................
Installer Address
Type of Building Size Lot,4;20....Sq. feet
U
Dwelling—No. of Bedrooms.._......_:_................................Expansion Attic Garbage Grinder (Other—Type of Building ............................ No. of persons____________________________ Showers Cafeteria (
04 Other fixtures .....................................................................................................................................................
Design Flow....___. _____gallons--gallons per person per day. Total daily flow--------------------------------------------galloWns.
Septic Tank—Liquid capacit' a lions Length________________ Width____-_-__--.-_.- Diameter_...._._______.. D�ey I I----------------
Disposal Trench—No. ...... ;;�4..... th.................... To l Le2$fth-------------------- Total leaching are, O)Lq. ft.
Seepage Pit .................... Total leaching area..................sq. f t.
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------------------------
44 Test Pit No. 2................minutes per inch Depth of Test Pit......_......______. Depth to ground water...________-_________-_.
9 - --------------_--_--_
0 Description of Soil____________ ------- ---------- ---
----------------------
U .......................................... ................... --------------------------------- -------------------------------------------------------------------------
W
�ii --------------------------------------- ..................... ------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------I----------------------------------
---------------------------------------------------------------------------------------*---------------------------------------------------------------------------------------------------------------
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 undersigned fur agrees not to place the system in
operation until a Certificate of Compliance has
been?_i�.0..e.. byt---------o-a-rd Of hA_aty.
nL ... . .igi ..... . . ----------------
-Date
Applicationppoy :
A d By�____ .70 -- -----�V_e e .................... --- ---- ----------
Date
Application Disapproved for the following reasons_____________________________---------------------------------------------------------------------...............
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued.........................................................
Date
c
No.- - F>c�..... '. ....
THE COMMONWEALTH OF MASSACHUSETTS
�--�� BOARD Q F HE LTA
I �
, pphration for 43hip at Works C omarnr#inn Prrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System.at'-= ............................................................
'y-,-L-G-oca ------ --=------=- ----- ....................................................
---- N--
� ✓
�st i'lrYt✓�� . ....
n-Addr ss�� ,.Gta /t or Loto�5 .....
l.. Owner ........................Address
_t----
� l Installer Address
UType of Building Size Lot..,/ _ S__ ___-Sq. feet
Dwelling—No. of Bedrooms-------------:3------------..............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ________________________••__ No. of persons............................ Showers ( ) — Cafeteria
aI Other fixtures _________________________________
w Design Flow........... ...e_:7/1_.._gallons per person per day. Total daily flow--------------------------------------------gallons.
Ix Septic Tank—Liquid capacity:_.- gallons Length................ Width---------------- Diameter---------------- Depth----------------
Disposal Trench—No........ '_ _ Width ----------
------ Total.Leggth---------------_--- Total leaching area___.__` ��sq. ft.
Seepage Pit No._�w _. Di eteT .. 60 t 6lo-ualet.................... Total leaching area------------------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.--____-_.___-_____-_---
r,4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-______________---.
P4 - - - ----------------•------•-----•-------------•--•-------------------------
O
Description of Soil ..f .... .......... ......-- - ------------------•--••----••----------•---•---•-
----------------
w
VNature 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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by tth�e`board of health. !1
Signed._ // ---- ...................... .f�`.!>//-• / J
7 °ace..............
Application Approved BY -'--•-•-••--•-------• ----------
Date
Application Disapproved for the following reasons:..............................---•-•-----•---•--•------------•-•--••--••-------•-----••-----•••.----------
-----------------------------------------------------------------------•-------•---•-------------.......-----•--•-•---•--• ------------------------•--•-•--------------------------------,-----------
�� to
PermitNo......................................................... Issued--. �---- -- -------------------------•-•
1e
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL H
OF.
il........... .... ........................................
�rr#if ira#r ,af Tomplianrr
THIS IS TOICERTIFY hat the Individual Sewa 'e Disposal System constructed (— or Repaired
by- ��! _ - �•/' -------------------------------------------------- - .........................
/ ---•Installer`' ✓ _ _ !a 7!_!L:-:'?!-------------•--.__•---
at---------- -—�'t—== !"/--------- - ' _ ",�f,c,__ /yfh ram_ •!((= .,._. . ./(-g'�fr
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- dated.-._-__--__________•-------_________-__--_------
' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL
/fF1UN ION S TISFACTORY.
DATE......... ---------r� 2__,.2-----------•-•-••---- Inspector......... ----------------•------ ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............OF_..../�.�.c- .9�,�/'- ---------�......--------
No.. ,--
FEE... _CV
Permission is hereby granted r" ------------------------•---•---•--•---
to Construe. ( or Repair ( ) an Individual Sewage Dis osa-1' System,//
at No........64n� -----..._ /1 .. =/� C '
Street
as shown on the application for Dis osal Works Construction Per :..__..__ Dated------------------------------------------
pplication
.......... ---------------•------•-
Board of Health
DATE...... -- ------- ---- -...3---=-------------------
FORM 1255 HOB S & WARREN. INC.. PUBLISHERS