HomeMy WebLinkAbout0034 OAK HILL ROAD - Health 34+OAK HILL ROAD.
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ASSESSOR'S MAP NO. ' �'� PARCEL
,.'O C A T-ION SEWAGE PERMIT N.O.
VILLAGE
INSTALLER'S NAME i ADDRESS
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i U I L D E R OR OWNER
DATE PERMIT ISSUED
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DATE COMPLIANCE ISSUED
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ASSESSOR'S MAP NO. 'g PARCEL '
LO"CATION SEWAGE PERMIT . RD.
6� ���� �� ��1
VILLAGE
INS�TA-�L_L It S NA`ME & ADDRESS ^
BUILDER OR OWNER ;
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=248083&seq=1 3/8/2011 '
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.Cz-. . w.......OF........
Appliration for Biopoottl Works Tonstrurtion 11rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
----•----- `-'a ....s .. ,,.... .. ._... --------- - '-5-----------------------------------------------
Location Address or Lob No.
..........�'n w....ZQ.r_.1A------------------------------•------------- ..................5_..Rom!' ` .. --.........._.
O ner Addre ss
�. � ....ti _. __, ._ ..�........---• -`t:4............
v installer
Address
Type of Building Size Lot................ Sq. feet
Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building
a Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures . -•........................:.................
Design Flow.......... '` .......................gallons per person per day. Total daily flow....._.__._���___
W .. ...........gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..:.:_� S,'...._.._._.. Width..... ..._...... Total Length.......-....... Total leaching area....................sq. ft.
_. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
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........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
a ----------------------
--------------------------------------------------
-----------
•--------
------------------------------------------
•-----•------
O Description of Soil............................................................................................................
V ...................•••••--•---....--•--•-•--------••-•------•-.......------•---------•---.......-••-•-•------------•----......-•------•------••-....--•--.....-------•--•-......-•-.................._...
W
U Nature of Rejpairs or Alterations—Answer when applicable._------4_10.0---_---.(-_ ... .�.at0 ... ' . l_Y_J-t��!
..... -----�- _ .. �Q Q . ----------------------------------------------
Agreement: .
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi.E 5 of the State Sanitary Code— The undersigned furth grees not to place the system in
operation until a Certificate of Complianc een Issue a boa iea
Signed... ----- T-----d�7O
� Dat
Application Approved By........................ ..... .......
Date
Application'Disapproved for the following reasons:---•------------------------•-------------------....----------------------------•---•-••----•-•---•--••--------
.........................••-..............--•---...-----•----•----•--•---•••----•-•----.....------••----.--------------...•-•••-•---•••-•-•-•-•------••------•--•---••--••••=•-----•---•..........._..._
Date
PermitNo... ............................... � ' �-l.S�.d_-I.... Issued..----......---•-----------•----...-•----...............
Date
THE.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C, ....
Appliration for Dispogal Works Tonstru'divit 1hrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
V
-47-----I------------------------------------------ .......................... ............ ..............................
Location-Address or Lot No.
k -. -- -, ............. .................... ...
. ............................................ ..................S. ..... ..................
Owner Address
......................................... ............ ........e;6:L4............
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.......(-,.;.L..............................Expansion Attic Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( )
04 Other fixtures ....................................................................
<4 "k------------------------------------------------------- ---------------
Design Flow......... .........................gallons per person per day. Total daily flow........... _n................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter......_--.-__._. Depth_...............
Disposal Trench—No. ...... ............ Width......._<'.......... Total Length--..... ....... Total leaching area....................sq. f t.
Seepage Pit No....._................ Diameter.................... Depth below inlet..........._.._..... 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...._...................
f;rq Test Pit No. 2................minutes per inch Depth of Test Pit--..............__.. Depth to ground water........................
.............................................................................................................................................................
0 Description of Soil.......................................................................................................................................................................
------------------------------------------------*-----------------------***------------*-------------------------------------------------------------*'*"*-----------------------
......................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable------ --------- r
....ru
............ .. ......S��'t. ............ ------------------------`----..._....---------
Agreement: —4
. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned by he &. further- agrees not to place the system in
operation until a Certificate of Complianc reFnFirsff-ed e-has- boarof_hea_'t_ �
4
- --------- -------_---------_- --- ----------
..... ...........
te
Application Approved By..................... 4
.......... .......... ....................
Date
Application Disapproved for the following reasons:..............................................................................................................
.......................................................................................................................................................................................................
Date
IssuedL.......................................................
Permit No.......................................1�61----
Date
THEi/COMMONWEALTH OF MASSACHUSETTS
'4. BOARD OF HEALTH
........OF....... ..............................
(Irdifiratp laf Toutphaurr
THIS ISJQ CER-T-L Y, That the Individual Sewage Disposal System constructed or Repaired k_)
by............................---------------- ..........................................................................................................................
............ .... Installer
at.................................... ... . k%4 \ I.. -.... ...o...
. .. .. ...
...............................
has;.,been installed in accordance with the provisions of 'J1Tj.:E* 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. 7�=6f7 .. dated._..'`?.. ..-- --- 1-721
------ 1_e Cam.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL fUNIGNON SATISFACTORY.
.............................. ........................................................
DATE............................C T Inspec tor........ .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . OF HEALTH
.............OF............ .......... .........
N .....1�p
....... FEE._ .
Disposal Workg- Tonstrurtion Firrmit
Permission is hereby granted-------- ....... ...................................................................................
to Construct or Repair (-)-an- Individual Sewage Di5posal System
at No. -. 7................... ........
1 n_1'!�......... - 1-4
------------------ ----- ...........................................
st'"t
as shown on the application for Disposal Works Construction Permit 1- Dated.._.... _Z I i:T-,
.......................... - - -- ........
---------------- ---- ------------------- ...................... .
Board of healthDATE........... B
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